Dr. Abdhalah Ziraba

Nairobi City, Kenya

In most of sub-Saharan Africa, under-five and infant mortality rates have been declining over the last 10 years but not neonatal mortality. Neonatal deaths account for about 60% of all infant deaths in Kenya. Healthcare facilities are few, poorly equipped and manned. Furthermore, nearly half of births occur outside of healthcare facilities.

Kangaroo Mother Care (KMC) intervention involves immediate skin-to-skin contact of mother and baby, frequent breastfeeding and maternal-infant bonding. Trials have shown that KMC at healthcare facilities can reduce neonatal mortality in preterm and low birth weight neonates. However, there is paucity of data on KMC at the community level where most of deliveries occur. This is even more critical for informal settlements with high levels of poverty, poor healthcare provision and weak household and community support mechanisms as is the case with Nairobi’s informal settlements. No conclusive studies have assessed the effectiveness of KMC at a community level in an urban poor setting.

As part of the Ministry of Health community health strategy for improving health, community health workers (CHWs) have been identified and trained to implement primary health care activities, including health education and provision of basic interventions in the community. By tapping this resource, the project will help implement a Kangaroo Mother Care package in two slums of Nairobi city.

Specific activities will include:
1. Training of CHWs on KMC; to develop training materials on KMC, counseling of pregnant mothers, recognition of complications and referral.
2. Support CHWs to implement KMC in the community. Working within their cluster households, the CHWs will: – Identify and counsel pregnant and new mothers
– Support mothers in providing skin-to-skin contact with the babies, exclusive breast feeding and identify danger signs
– Recognize danger signs among neonates
– Refer neonates with complications for further management.

The proposed intervention will be delivered by Community Health Workers (CHW) and will not only help prevent hypothermia and poor nutrition; it will also empower mothers to identify danger signs. As a result, a larger number of sick babies will receive treatment or will be referred for further management early and thus help prevent deaths from other important causes such as septicemia and pneumonia.

The novel idea in this project is around the delivery of KMC at a community level irrespective of whether birth occurred at home or in a healthcare facility and secondly the use of lower health care cadres, the community health care workers in delivering the intervention. All pregnant mothers will be followed until they give birth and the birth weights of babies will be taken as well as an estimation of the gestation age. In terms of content, the health facility based KMC is the same as the CKMC with the only difference being the place it is offered and the cadre who offers/trains mothers to carry out KMC.

Dr. Abdhalah Ziraba is an Epidemiologist and a Medical Doctor. His research interests include reproductive, maternal, newborn and child health, HIV/AIDS, health systems research, health and demographic surveillance, estimation of mortality in environments with poor or no vital registration and exploring quantitative research methodologies.

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