By Judith Grace Amoit
Globally, 2.3 million children died in the first month of life in 2022, and approximately 6,300 neonatal deaths every day. This staggering statistic from the World Health Organization (WHO) underscores a critical global health issue that often remains covered in silence. When a preterm baby dies, the world rarely pauses to notice. This silent tragedy raises a deeply unsettling question: how many people make noise when a preterm baby dies?
In Uganda, the situation mirrors the global crisis. According to the 2022 Uganda Demographic and Health Survey (UDHS), preterm birth is a leading cause of neonatal mortality, accounting for a significant proportion of the 22 neonatal deaths per 1,000 live births reported in the country. Despite these alarming figures, the deaths of preterm infants often receive minimal attention, both in the media and in public discourse. This lack of attention reflects a broader societal neglect and highlights the urgent need for effective interventions like Kangaroo Mother Care (KMC).
KMC, a method that involves skin-to-skin contact between a mother and her preterm baby, has been shown to significantly improve the survival rates of these vulnerable infants. This practice promotes thermal regulation, breastfeeding, and bonding, all of which are crucial for the health and development of preterm babies.
The Omwana Trial, a research study conducted in Uganda, further emphasizes the effectiveness of KMC. This trial demonstrated that preterm infants receiving KMC had a substantially higher survival rate compared to those receiving conventional care.
Dr. Oyella Shiela a paediatrician, and also a passionate advocate for KMC, shared her poignant experience through the OMWaNA KMC webinar. As a mother who practiced this lifesaving method, she recalls the emotional and physical struggles, the long hours spent holding her fragile child close to her chest, and the hope that KMC instilled in her during those critical early days. But her story takes a somber turn as she poses a stark question: “How many people make noise when a preterm dies?”
Her question is a call to action, highlighting the broader societal neglect of preterm mortality. Unlike other health crises that garner widespread attention and advocacy, the deaths of preterm infants often go unnoticed. This lack of attention underscores a significant gap in our healthcare systems and societal priorities.
The silent deaths of preterm babies in Uganda are not just statistics; they are real lives lost, each representing a family devastated by grief. In many parts of Uganda, particularly in rural areas, healthcare facilities are under-resourced and ill-equipped to handle the needs of preterm infants. The lack of incubators, trained staff, and essential medical supplies means that many preterm babies do not receive the care they need to survive a cry that is similar to that of Mulago Specialized Women’s Hospital’s preterm deaths linked to non-functional machines. This dire situation calls for urgent action and investment in healthcare infrastructure.
When a turn is taken on the economic evaluation side, KMC offers a feasible and cost-effective solution, especially in resource-limited settings. The Omwana Trial provides compelling evidence supporting the adoption of KMC across Uganda. The trial found that KMC not only improved survival rates but also had significant benefits for mothers, including increased breastfeeding rates and reduced stress. Despite these positive outcomes, the implementation of KMC remains inconsistent, hindered by inadequate infrastructure and lack of awareness.
The success of KMC hinges on several factors, including the availability of space for mothers to stay with their infants, training for healthcare workers, and community support. Many hospitals in Uganda lack the necessary facilities to fully implement KMC. Basic needs like adequate space, proper sleeping arrangements for mothers, and continuous training for healthcare workers are often in short supply. Enhancing these facilities would not only support the effective practice of KMC but also ensure that more preterm babies have a fighting chance at survival.
Infrastructure improvements at KMC sites are vital to addressing this issue. For example, the construction of dedicated KMC units within hospitals can provide the necessary environment for mothers and babies to thrive. These units should be equipped with comfortable beds for mothers, adequate heating, and access to clean water and sanitation facilities. Additionally, healthcare workers must receive regular training on the benefits and techniques of KMC to provide consistent and effective care.
The silence surrounding preterm deaths is not just about the physical infrastructure but also about societal awareness and advocacy. When a preterm baby dies, the impact is profound and far-reaching, affecting families, communities, and healthcare providers. Yet, these deaths rarely make headlines, and public outcry is minimal. This silence perpetuates a cycle of neglect and underfunding for preterm care initiatives.
We must break this silence. The voices of mothers and family members should be integrated into KMC design through creative co-creation methodologies. The voices of mothers like Dr. Oyella, who have experienced the power of KMC firsthand, are crucial in this effort.
Moreover, government and non-governmental organizations must prioritize funding for maternal and child health programs, with a specific focus on preterm care. Additionally, the government must take on an investment case for newborn care and make it central and, Policymakers need to recognize the importance of these investments and allocate resources accordingly.
The silent tragedy of preterm deaths is a call to action for all of us. We must not let these deaths go unnoticed. Instead, we must make noise—loud and clear—to demand better care for preterm infants, to support the families who grieve for them, and to ensure that every preterm baby has the chance to survive and thrive. By breaking the silence, we can turn the tide on preterm mortality and create a future where every baby, regardless of their birth circumstances, has a fighting chance at life.