Prematurity and Low Birth Weight

Complication from preterm birth, including prematurity and low birth weight (LBW), is the leading cause of newborn mortality in the world, accounting for approximately 35% of all newborn deaths. Kangaroo Mother Care (KMC)—an alternative approach for providing thermal care for LBW infants—is a proven intervention to save an estimated 500,000 newborn infants from dying in their first month of life. However, while KMC has existed for more than 30 years, few countries have adopted or adapted the technique. MCHIP is trying to change this, engaging at global and country levels to promote its scale-up, and supporting the introduction and/or expansion of KMC services in over 15 countries in Africa, Asia and Latin America & the Caribbean (LAC).

Another proven but neglected intervention for preterm births is the use of antenatal corticosteroids to accelerate fetal lung maturation during spontaneous or induced preterm labor or elective cesarean section (for maternal conditions such as pre-eclampsia or eclampsia). If antenatal corticosteroids are provided during preterm labor, it is estimated that approximately 340,000 newborn lives could be saved every year. MCHIP through Born too Soon, the UN Commission on Lifesaving Commodities, and the USAID Survive and Thrive GDA is working with various global agencies1 to catalyze action on country adoption and scale-up of this intervention. The MCHIP Newborn and Maternal Teams, as members of the Survive and Thrive GDA Preterm Working Group, are collaborating with other partners to develop a learning package for countries to adapt and use as they seek to improve care for preterm births. The recent global newborn health conference co-hosted by MCHIP assisted in creating awareness of the need to scale-up these two interventions with a number of countries making commitments to adopt them.

Evidence-based Interventions to Care for Premature/LBW Births

There are three main evidence-based interventions that have significant impact on improving the survival of preterm or LBW babies: KMC; antenatal corticosteroids during preterm labor; and incubator care. A recent meta-analysis showed that KMC is actually more effective than incubator care in middle-income countries. Use of KMC and antenatal corticosteroids in low- and middle-income countries is estimated to save approximately 500,000 and 340,000 newborn infants, respectively. Identification and appropriate management of certain maternal conditions such as pre-eclampsia, eclampsia, antepartum hemorrhage, malaria and syphilis would reduce incidence of preterm births and LBW babies.

Key Activities

Malawi is one of the countries supported by the Program to expand its KMC services. MCHIP’s predecessor, the ACCESS Project, working with Save the Children’s Saving Newborn Lives project, had laid the foundation and began the expansion of KMC services in the country. In line with MCHIP’s equity strategy of ensuring newborn health services are provided along the household-to-hospital continuum of care, the Program supported the training of service providers and establishment of KMC services at district hospitals and health centers in four of the country’s 28 districts. Where needed, health facilities were provided with basic equipment such as weighing scales, thermometers, graduated feeding cups, mattresses and pillows. In addition, Health Surveillance Assistants (Community Health Workers paid by the Ministry of Health) were also trained in community KMC.

In LAC, MCHIP’s KMC Implementation Guide has been translated into Spanish and, in collaboration with members of the LAC Neonatal Alliance,2 the Program developed and coordinates a regional KMC network of nine implementing countries
MCHIP has also implemented and expanded KMC in four centers in the Dominican Republic, and implemented the approach at three KMC centers in Paraguay.

Results

MCHIP supported the establishment of KMC services in 36 health facilities in Malawi—or about one-quarter of the country’s 121 health facilities currently providing these services. Moreover, the Program trained 125 service providers and approximately 300 Health Surveillance Assistants in community KMC.

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1 Including WHO, UNICEF, USAID, American Academy of Pediatrics, American Congress of Obstetricians and Gynecologists, and American College of Nurse-Midwives

2 Colombian Kangaroo Foundation and URC/ASSIST