In one world, Tabitha Wanjiku is shimmying under cars, tweaking transmissions and rewiring brake lights on her way to certification as a mechanic. In another, the soft-spoken, 19-year-old mother is learning how to keep her premature baby alive.
Sitting on a bench in the newborn unit of Kenyatta National Hospital (KNH) in Nairobi, Wanjiku has taken time off from her studies to participate in a program called Kangaroo Care. She peels back several layers of clothing to reveal a tiny infant nestled against her chest.
Mothers in the Kangaroo program learn to cuddle their babies to their abdomens and – literally – wrap them in swaddling clothes. The key is skin-to-skin contact and surrounding the baby with traditional cloth wraps or special blankets. Preterm babies don't have enough fat to warm their tiny bodies, but their mothers can serve as a human incubator to keep them alive while they gain weight.
The Kangaroo Care concept was developed in the 1970s by two Colombian pediatricians seeking a solution to shortages of incubators and hospital staff. The low-cost, low-tech technique turned out to be surprisingly effective at boosting the survival rate of babies born before the the 37th week of pregnancy, according to a report on preterm births by the non-profit, U.S.-based March of Dimes that involved the work of more than 50 organizations worldwide.
Kenyatta Hospital introduced the initiative in 2000 to combat surging newborn mortality rates – particularly among preterm babies. KNH sent two nurses to Colombia to learn enough about the technique to help launch the program.
Nearly half of the 1.1 million babies who die each year from preterm birth complications could be saved using the Kangaroo Mother Care technique, according to the March of Dimes report. The World Health Organization endorsed the technique in 2003 and developed a practical field guide for health professionals in preterm care.
The potential of Kangaroo Care has particular implications for the developing world, which is hardest hit by premature births. Of the 11 countries with preterm birth rates over 15 percent, nine are in sub-Saharan Africa, the March of Dimes report says. More than 60 percent of preterm infant deaths occur in sub-Saharan Africa and South Asia.
Pauline Wambui, 28, knows firsthand the fear of losing a child. The mother of two had a smooth first pregnancy, but her second child arrived prematurely. "I was so scared when she was born that I might lose her," she says. "The baby was so small it was even hard to hold her."
Wambui joined KNH's Kangaroo Care program and says both she and her new daughter have benefited from the initiative. "You feel that mother-to-child love, and it has helped the baby to gain weight," she says.
KNH nursing officer Evelyn Ndiga says that many new mothers opt for Kangaroo Care over the incubators. "When [the infants] are in the incubators, they are not in touch with their babies, but with Kangaroo, the body touch is there," she says. Babies in the Kangaroo program also tend to gain weight faster than those kept in incubators, she adds.
The benefits extend beyond the doors of KNH's newborn unit. "Those mothers who do Kangaroo Mother Care, their babies are able to be discharged below two kilograms because we are comfortable that the mother will be able to take care of the baby at home," Ndiga says.
Scientists and medical professionals back Ndiga's experience. Multiple studies have concluded that Kangaroo Care is as safe and effective as an incubator. As an added benefit, Kangaroo Care has been shown to improve success rates for breastfeeding – one of the most important measures for protecting newborn babies. The technique has been proven to boost brain development, cut infection rates and strengthen the mother-child bond.
The method costs a fraction of an incubator. At KNH, mothers can expect to pay an extra 800 shillings (U.S.$9.32) daily to use the machine. That is too high for many families in a country where the average annual income for 2011 was less than U.S.$800. Even if parents have the funds, the hospital has a limited number of incubators.
Despite the benefits of the Kangaroo method, participating mothers without a supportive spouse or health care network may find it difficult to follow through with the long periods of skin-to-skin contact. At KNH mothers are expected to come to the newborn area for a Kangaroo session every three hours. Wanjiku has taken the year off from her mechanic studies and relies on her husband for financial support.
Although the Kangaroo method seems intuitive, mothers must master techniques for swaddling their babies to provide the maximum amount of insulation. They've also got to keep a stringent breastfeeding schedule and monitor changes in their infants. Most of these skills must be taught, but many mothers in developing countries don't have access to the information.
Funding shortfalls also block the spread of Kangaroo Care to areas where its potential to save lives is significant. Only 10 percent of extremely preterm newborns survive in low-income countries, compared with more than 90 percent of those in high-income nations, according to the March of Dimes study. Kangaroo Care could be key to changing these statistics, says a 2010 study published in the International Journal of Epidemiology.
At KNH space constraints have prevented the hospital from adopting the full Kangaroo Care model. Mothers leave their infants in the incubators overnight instead of sleeping with them.
"When they go away and leave their babies here, they are distressed. They don't know what's happening to their baby," Ndiga says. But mothers still see vast improvements in the part-time program.
Ndiga is confident that rolling the program out across the country could improve the lives of rural mothers too, few of whom have access to incubators. "We don't require much to do it, and it's quite cheap to implement," she says. "Our workload would be less if we implemented it elsewhere, because we're getting preterms [referred] from all over."
Wambui is optimistic about the future, particularly the day when her daughter is more independent. "I am so excited to see her [grow up] after all I've gone through with her," she says. "I will remember where she has come from."