While Early Essential Newborn Care (EENC) and Kangaroo Mother Care (KMC) practices for term babies were found progressive, there is a need for improvement for preterm babies.
This was one of the findings of an assessment of EENC and KMC carried out in three referral hospitals in February last year, a year after the EENC and KMC were implemented in the hospitals.
Programme officer with reproductive maternal and newborn health programme, Pema Lethro said the assessment was carried out to identify key policy and system strengths and gaps in the three hospitals and to recommend hospital managers and staff to implement next steps for continued progress.
EENC and KMC were implemented in the hospitals with the coaching of 112 doctors, nurses and specialists in February 2017 in an effort to reduce the newborn mortality rate.
Newborn deaths contributed about 56 percent of under-five mortality.
“Since EENC and KMC focuses on improving quality of intrapartum and newborn care in first 24 hours after birth, this is where we require strengthened health systems,” Pema Lethro said.
EENC and KMC are part of Bhutan Every Newborn Action Plan (2016-2023).
In Bhutan, 278 newborns die out of total 12,000 live births annually, mostly at the time of birth and during the first week.
One in 10 live births are estimated to be preterm accounting to a total of 1,300 pre-term or low birth weight per year.
Currently, Bhutan’s newborn death rate stands at 21 per 1,000 live births and stillbirths at 14.9 per 1,000 live births. The action plan aims to reduce newborn death rate to below 13.2, and stillbirths to 12.1 by 2023.
He said reducing newborn mortality is one of the priorities of the 12th Plan.
EENC is the care given to a baby during delivery and the first days after birth. It includes three principal components.
The first one is embrace which involves drying of the baby as soon as the baby is delivered. “The baby is then put in the skin to skin contact and then we practice delaying of clamping the umbilical cord and we make sure there is early institutional breastfeeding,” he said.
He said KMC is care of preterm infants carried skin to skin contact with the mother. “Even fathers can put baby skin to skin contact and this is called partnership.”
Feeling of safety, breastfeeding, warmth and comfort, better bonding, less stress and emotional development are some of the benefits of KMC.
Health ministry jointly with UNICEF and WHO carried out the assessment to assess the knowledge and skills of participants on EENC and KMC practices before and after the coaching.
The assessment found that positive practices for term babies such as skin to skin contact just after birth, skin to skin contact within one minute of birth and breastfeeding within the first hour of birth were in practice in these hospitals.
It was found that babies first breastfeed before separation from the mother, keeping in uninterrupted skin to skin for 90 minutes, babies completing all first embrace tasks, breastfeeding for at least 15 minutes and feeding both early and exclusively were low.
It also found that few preterm babies received any skin to skin contact and many were admitted to the Neonatal Intensive Care Unit (NICU) for observation even if stable.
“If the hospital has a separate KMC unit then we need not put preterm babies in NICU because NICU is also a place where we could have potential infection,” he said.
Some core health system strengths and gaps around supplies and equipment, guidelines, hospital data and health workforce were noted in the three referral hospitals.
He said that none of the three hospitals had hospital breastfeeding policies and practice recommendations displayed in wards or public areas. “These are small things but matter a lot.”
It recommends continued coaching of health professionals in EENC and KMC at all levels; more infrastructure like KMC beds, space and mannequins for KMC practices; team building, routine monitoring and supervision in these hospitals.