Preterm death accounts for 37 percent of neonatal mortality in the country

Born at six months, his son weighed only 900 grams. Samten said his son could fit in the palms of his hands. “As a parent I did not see any hope of my baby’s survival. I had given up but my baby survived.”

The father said his baby survived because of the care given at the referral hospital’s neonate department. “Seeing the babies’ condition, the parents lose hope but during those times, the nurses and doctors were cooperative and took good care of the baby.”

Preterm births or premature babies are born at 37 weeks and less.

During Samten’s 89-day stay at the neonate ward, he learnt about Kangaroo Mother Care (KMC). He and his wife took turns giving skin-to-skin contact to the baby, sometimes for almost 20 hours a day. “It is helpful in helping the baby gain weight. In a day, the baby gains around 300 to 400 grams.”

Programme officer with reproductive maternal and newborn health programme, Pema Lethro said that Early Essential Newborn Care (EENC) and KMC-‘the first embrace’ focuses on prevention and care of preterm and low birth weight babies as well as sick newborns. “EENC and KMC are simple, practical, cost-effective, acceptable interventions in preventing newborn deaths.”

According to World Health Organisation (WHO), Bhutan’s preterm birth is estimated at about 1,400 each year, which means there is one preterm birth for every 10 live births. The Annual Maternal and Neonatal Deaths Review found that about 37 percent of neonatal mortality in the country is due to preterm death.

EENC and KMC are part of Bhutan Every Newborn Action Plan (2016-2023), which was launched on November 17 in Thimphu.

Bhutan Every Newborn Action Plan (2016-2023) was adapted from Global Every Newborn Action Plan with support from UNICEF.

Bhutan’s newborn death rate stands at 21 per 1000 live births and stillbirths at 14.9 per 1000 live births. The action plan aims to reduce newborn death rate to below 13.2, and stillbirths to 12.1 by 2023.

The action plan identifies six intervention packages- preconception and quality of antenatal care; immediate newborn care; care during labor and child birth; care of small and sick newborn; care of healthy newborn, and care beyond newborn survival.

Preconception and quality of antenatal care includes iron folic supplementation, prevention of anemia, and prevention of cervical cancer and involving health care providers in preconception and maternal nutrition counseling among others.

Immediate newborn care includes actions such as training health care providers attending immediate newborn care and neonatal resuscitation, instituting uniform measuring practice for head circulation, weight and length in all health facilities.

Ensuring functional wash facilities, strengthening the maternity wing and neonatal units with trained health care providers and strengthening referral mechanism to ensure timely referral, and use of referral checklist are among the plans for care during labor and child birth.

Actions for care of small and sick newborn include making neonatal care unit in district hospitals and BHU grades, establishing newborn human milk bank, including feeding support for babies, making phototherapy machines and serum or transcutaneous belirubin measurement available in all district hospitals and BHU grade I.

Dr Suraj M Shrestha with WHO said most preterm births happen spontaneously. “Common causes include multiple pregnancies, infections and chronic conditions such as diabetes and high blood pressure.”

He said that risk factors for preterm birth include having a previous premature birth, pregnancy with twins, triplets or more, an interval of less than six months between pregnancies, conceiving through in vitro fertilisation, problems with the uterus, cervix or placenta, being underweight or overweight before pregnancy and stressful life events.

Other causes include early marriage or pregnancy, ill effects of tobacco, harmful use of alcohol, and maternal malnutrition.

President of Khesar Gyalpo University of Medical Sciences of Bhutan, Dr Kinzang P Tshering, said that both children and adults need good quality diet. “We now know that the problem starts before pregnancy. Women and girls who are not healthy and well-nourished are at risk of having preterm babies, who are in turn at risk of being malnourished.”

UNICEF Bhutan representative Rudolf Schwenk said that preterm newborns are weak and underdeveloped with low birth weight, making them vulnerable to health issues. “Babies who do survive often have lifelong health problems such as congenital disorders, cerebral palsy, vision and hearing loss, and intellectual disabilities.”

He said the action plan is timely and a roadmap towards accelerating the reduction of newborn deaths. “This will have great significance in preventing premature birth, saving premature newborn and letting them thrive through appropriate care and feeding.”

Karma Cheki