Progress made in child care but more work needed

Kibungo Hospital located in Ngoma district, Eastern Province, handles between 75 and 85 babies per month in its neonatal section despite having only seven infant incubators, seven nurses and two doctors trained in that line. While international standards for neonatal care require that each nurse attends to a maximum of 4 babies in one go, the case is different in this facility. According to Michel Kubiza, a nurse at the hospital, sometimes they are forced to have one nurse attending to more than 6 babies at the same moment because of shortage of staff. “Sometimes there about 10 infants in need of incubation at the same time, but it is difficult to give all of them that service because incubators are not enough,” Kubiza remarks. A neonatal care section refers to an intensive-care unit specializing in the care of ill or premature new-born infants, usually 28 days and below. According to Sarah Isimbi Mugwaneza, a sales and marketing officer with DASH-S Technologies, a local firm dealing in supply of medical equipment, there is need to acquire more equipment and increase in-house training of staff if the quality of neonatal care provided is to improve. “Acquisition of latest equipment is one thing, but ensuring that staff know how to use them is another,” said Mugwaneza. The 2010 Rwanda Demographic and Health Survey, (DHS), says that 27 infants die out of every 1000 live births. And the commonest risk factors are unsafe and unhygienic delivery environment, home births, delays in seeking skilled medical care, and poor antenatal care. The report also points out that Asphyxia (inadequate oxygen) is the leading cause of death for newborns taking about 38%, followed by complications of premature births with 26%, and neonatal infections with 16%. According to Dr Ferdinand Bikorimana, the in charge of child health at Rwanda Biomedical centre (RBC), neonatal deaths account for more than a third of all deaths in children under 5. Efforts All the 42 district and 5 referral hospitals countrywide offer neonatal services. Each hospital has at least one doctor and two nurses trained in that line. According to Mugwaneza, her firm trained about 38 nurses countrywide on use of such latest equipment at a cost of Rwf7million about two weeks ago. However the 2013 Health Management Information System (HMIS) report shows that neonatal deaths have reduced from 27 since 2010 to 21 per 1000 live births currently. Bikorimana says that RBC has a team of 50 trainers who carry out quarterly training of neonatal care staff at every hospital countrywide. And that every public hospital has a minimum of 4 infant incubators. “We advise pregnant women to always seek timely antenatal care but also immediate medical care whenever they feel sick so as to reduce chances of premature birth or poor health of newborns,” he noted. The government is also promoting the use of Kangaroo Mother Care (KMC) method, a technique which offers affordable and effective alternative to incubator care, where by the mother places her newborn — usually premature — on her chest, between her breasts and ties a cloth around it. The baby is wrapped in a gown, tailored to resemble a kangaroo’s pouch every day until it is in good health and size. The method which enables skin-to-skin contact between mother and baby can save preterm and low birth weight babies in high- and low-income settings alike. The system which provides ready access to breastfeeding, originated from Colombia in 1978, and has since been proven successful in countries such as Haiti, Vietnam, and Rwanda. The system now approved by the World Health Organisation was first introduced in Rwanda in 2008, seeing a successful roll out in all public hospitals. A three day international meet on KMC just concluded in Kigali last week, and according to officials, part of the aim was to share best practices as far as the method is concerned. “However, the KMC is not a perfect replacement for the incubator, the former does not handle very critical cases, so the two have to work alongside each other,” warns John Baptiste Nkuranga, a paedetrician who doubles as the director of Rwamagana district hospital. According to the UNICEF 2014 report, the worldwide neonatal mortality rate fell by 40 per cent between 1990 and 2013 - from 33 to 20 deaths per 1,000 live births. Over the same period, the number of newborn babies who died within the first 28 days of life declined from 4.7 million to 2.8 million.