Quick Action Can Save Infants From Suffocation At Birth

Business Daily (Nairobi)

Immaculate Karambu

27 April 2011

In 1998, Dr John Wachira and other medical student colleagues were sent out to hospitals across the country to work as interns.

That period proved a turning point in Dr Wachira’s career. He discovered a method that is now being used to save babies from death at birth under a programme dubbed Helping Babies Breathe (HBB), which he champions.

His ability to think fast during emergency situations saved many lives and he is sharing the knowledge with colleagues.

“Whenever people talk about emergency, they rarely think about children but focus on adults,” said Dr Wachira.

Local hospitals rarely have Intensive Care Units specifically for children. Kenyatta National Hospital (KNH), the country’s largest referral hospital, had existed for a century without one until three years go.

Every year, about four million babies die globally during their first month of life.

According to a 2007 report by UNICEF, three main factors account for more than three quarters of global newborn deaths, commonly known as neonatal mortalities.

Pre-term or low weight births take the highest toll at 27 per cent followed by infections such as pneumonia with 26 per cent and asphyxia ( complications in breathing) accounting for 23 per cent of the mortality rate.

While it is estimated that about one million babies die every year around the world due to breathing complications, a considerably huge number of the three million annual stillbirths can also be blamed on suffocation.

A baby who is denied oxygen during any phase of the birth process faces a serious hazard of suffering permanent injury or disability.

But less than one per cent of the total asphyxia conditions call for medical treatment.

Estimates also show in only seven per cent of births is there usually an attendant at hand with the basic skills to help a baby breathe.

This is the gap that Dr Wachira and others involved in the ongoing HBB programme hope to fill.

The programme began in 2009 and the overall aim is to reduce the number of neonatal mortalities linked to asphyxia.

According to Dr Wachira, simple procedures such as rubbing the baby while keeping it warm can help open the airway and allow breathing.

This way, mothers can forget slapping a baby’s bottom while holding the infant upside down — a practice that doctors say may cause brain haemorrhage and dislocation of a baby’s joints.

“Not all infants with breathing difficulties need surgical interventions. All that most babies require is to be kept warm. You can also use a mask and bag to clear the airway,” he said.

But when faced with such emergencies, health workers tend to think of “big” solutions at the expense of the child’s life.

“I remember when I was still young in the profession and such a case occurred. We were all confused and did not know what to do. This training is important for all health workers,” said Dr Lawrence Owino, a consultant paediatrician and child health specialist.

If the training proves successful, Dr Wachira will not regret that Sunday afternoon at Embu Provincial General Hospital when two patients were brought into the facility complaining of breathing difficulties.

As an intern and with little experience in the field, Dr Wachira could not do much.

All the two patients died. Three others were brought in with the same problem an hour later.

“The situation was getting out of control. Information I got from the crowd milling outside the wards was that the patients had drunk poisoned alcohol,” he said.

But what could a medical practitioner do in a situation that also called for police action?

“The first thing was to ensure that the patients were in a stable condition before engaging the police on the matter. Normally, alcoholic drinks are laced with methanol and its treatment is ethanol which was then stocked in small quantities in hospitals,” he added.

Dr Wachira sent for vodka with a 70 per cent alcohol concentration, although he had a hard time convincing the hospital’s administrators to buy the spirit. His efforts managed to save 27 patients. Ten however died.

HBB comes in handy to supplement what local medical training offers.

But the few trainees we interviewed said they did not undergo such training at the medical school.

Last year the Ministry of Medical services adopted a resuscitation programme highlighting life-saving practices for newborns in the first 48 hours of life.

HBB is tailored along programmes that have existed in the developed nations where neo-natal deaths as a result of asphyxia record almost insignificant figures.

“Since September last year when the HBB programme was rolled out, we have been training between 25 and 30 people every month,” said Dr Wachira.

He says they plan to decentralise training from Nairobi to other regions if they get sponsors for the programmes.

In the current phase, institutions like the Rotary International, Kenya Paediatric association (KPA) and the government are behind the initiative.

Training costs Sh500,000 for a month. In addition to training on resuscitation, HBB has added malaria and TB management among other local health challenges.

But the initiatives can only work if more pregnant women visit health facilities.

Currently, only about 40 per cent of pregnant women give birth in hospitals while in only 22 per cent of total births is there equipment to help a baby breathe.

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