One health worker's mission to end newborn deaths

Guest Blogger: Louisa Muteti, Head of the Midwives Association, Kenya

My experience as a midwife dates back more than thirty years ago. I trained as a registered midwife in Mater Misericordiae Hospital in Nairobi. My reason to train as a midwife was prompted by a death of a child in paediatric ward due to severe Protein Energy Malnutrition (PEM) at Agakhan Hospital in Nairobi.

This 3 year old girl was brought in at 7.30pm to the Children’s ward in Agakhan Hospital. The vital signs were within the normal range except a slightly raised temperature. The evening shift staff handed over the child to be seen by the clinician. In the morning when we reported on duty our child from the previous evening was missing. On further enquiry I was informed that she was among the two reported deaths in the ward that night. I was very disturbed to note that malnutrition could claim a child that easily yet it was completely a preventable condition. My big question was: What can I do to facilitate prevention of such deaths?

The incident of the death of the severely malnourished baby haunted me to the extent that I decided to resign from Agakhan hospital where I was working as qualified staff nurse to go to train as a registered midwife. This way I could seek public service employment to be deployed in the community where the malnutrition seemed to arise from. That was the major reason to work in the community where I am still working in the rural Kenya to address malnutrition with other health determinant factors like development.

Since the time I trained as a midwife and was deployed by the public service, I realized the problem of malnutrition was far bigger than just the few numbers I saw being affected. The community knowledge, attitude and practices in health promotion and disease prevention were diverse with a lot of myths and misconceptions in relation to maternal, infant, and child care. Food in security, storage, preparation as well as the feeding habits formed a big portion of the challenges to overcome even - thirty years since I started..

Saving Lives of Newborns

As a midwife I realized that the health of the mother determined the newborn’s outcome at birth and survival later on. To save the lives of the newborns, I have forged partnerships with multidisciplinary team members in the community. Through these partnerships, I have been able to address issues around pre-conception care like screening of conditions like diabetes, high blood pressure, sexually transmitted diseases like gonorrhea, syphilis including HIV. Then through close surveillance during pregnancy we have been able to avoid fetal congenital malformations or maternal complications and avoid unnecessary deaths. Encouraging pregnant women to use pre-natal clinics as soon as they realize that they are expectant is a core message. The use of micronutrients like iron and folic are supplied to mothers so that their babies can be prevented from developing neural tube congenital conditions.

My practice as a midwife has included – nurse/ midwifery duties in direct patient care (Clinical midwifery care) in the ward, hospital, regional and now county nursing and midwifery administration. In my practice I have not lost any babies during delivery because of close monitoring of the fetal heart rate during labour. However, I have noted the loss of newborns that have been discharged from the hospital looking health only to suddenly change condition and die within hours or days after birth. These neonates who die are thought to have died as a result a maternal condition or environmental challenges like cold or very hot weather. In some cases, the cause is related to socio-cultural practices especially the handling of the umbilical cord stump. In communities where personal or environmental hygiene is poor more babies have tended to die from neonatal sepsis acquired through contaminated umbilical cord stump leading to Neonatal sepsis (or infection).

In addition to poor hygiene leading to infected cord, or early mixed feeding where the neonate is not exclusively breast feed, gastro- intestinal conditions like diarrhoea and vomiting are common. Neonatal tetanus is a real challenge in communities that keep domestic animals due to contaminated environment (dust) or direct application of cow dung or other contaminated substances to the cord stump. Alternatives that are effective in keeping the umbilical cord free from any contaminants need to be introduced for use in these communities.

A Way forward in Saving Newborns

The most critical strategy to save the newborns lies in community education and health promotion for effective behaviour change. These should address socio- cultural practices that affect the newborn’s wellbeing. Among these is exclusive breastfeeding up to 6 months followed by appropriate complimentary feeding but not to cease breastfeeding unless the mother has a medical challenge like HIV infection etc.

There is also need for advocacy for effective and efficient pre-conception care for women who are planning to become mothers within six to three months before expected conception. This way any medical conditions that can predispose poor neonatal outcome will be known and controlled. This is one of the main reasons why midwives will recieve extensive community education carried out alongside other health care services to the selected communities during the International midwives week later this year.

With the right training a midwife can actually facilitate the saving of life of both mother and newborn and reach mothers in even the most remote regions.

Thank you for reading part of my story, be blessed indeed.