Assignment 2: KMC Global: Ghana Ghana o Household About 1/3 are women 40% of Ghanaian population is under age 15 Families often live with extended family members Tradition of either move in to live with their mother or have their mothers to move in around the time of childbirth o Grandmothers are highly influential in making decisions concerning the care of the newborns o Education 1 out of 5 women and 9% of men are uneducated Overall, men are more likely to be literate than women 2/3 of women are literate, and 82% for men o Fertility rate Fertility rate has decrease from 6.4 births per woman in 1988 to 4.2 births per woman in 2014 Fertility rate also varies by the region, women in urban area has 3.4 children on average where women in rural area might have 5.1 children per woman o Birth 14% of adolescent women (age 15-19) are already mothers or pregnant; it is common in rural areas 91 percent of births was assisted by a skilled provider and was delivered in a health facility in Urban area 59 percent of births were assisted by a skilled provider and 58 percent was delivered in a health facility in Rural area o Ghana ranks 23th in the world for the preterm births 128,000 babies are born before 37 weeks of pregnancy 7,900 newborn are dead due to preterm birth Three main caused of death: Infection: 32%, Prematurity: 26%, Asphyxia: 23% Millennium Development Goal 4 32% of deliveries take place outside a health facility and birth weight is not measured Low birth weight (LWB) : weight less than 2.5kg o Ghana LBW 13-14% KMC o Four components of kangaroo mother care Securing the baby in an upright skin- to- skin positioning of a baby on the mother s chest Adequate nutrition through breastfeeding (only breast milk)
Ambulatory care as a result of earlier discharge from hospital and with the support of a follow- up system Keeping the infant as long as possible More than 20 hours a day is called continuous KMC A few hours a day is called intermittent KMC or kangaroo care (KC) o Support for the mother and her family in caring for the baby. o The benefits of KMC Physiological effects: improves the physiological stabilization of the infant (heart rate, respiratory rate and etc.,.) Behavioral effects: Infants receiving KMC have more mature and enhanced sleep patterns Breastfeeding: milk production is better, and longer duration of lactation Psychosocial effects: facilitates maternal and infant interactions and attachment Neurobehavioral effects: improved general development o Training remains confined to hospital settings KMC is continued at home after discharge with routine follow up visits scheduled to weigh the baby, and check for danger signs KMC was practiced in Ghana in 2007 o Started with four regions: Central, Northern, Upper East, and Upper West Regions Consists of three phase The first phase: introducing KMC concept, basic information, and skills needed to start practicing. Second phase: more advanced workshop for committee members in each region; provide progress feedback, and discussing possible solutions Third phrase involved the assessment of progress with KMC implementation Level of neonatal care in Ghana Level 1: provides basic care for healthy newborns Level 2: Provides special care for low birth weight, high risk and moderately sick newborns. o Limited resources with well trained nursing staff, medical supervision Level 3: NICU, cares for very sick newborns and needs specialized medical and nursing staff and costly equipment o Within the four regions, regional steering committee was nominated; total of 6 monitoring teams were trained. One for each of the smaller regions and two for the two larger regions. Every team has 3-4 members.
The training consist of 3 components Two- day preparation workshop o Introducing the progress monitoring tool Visit to each district and regional hospital o Each team will be accompanied by 3 facilitators who are experienced 1-2 day debriefing workshop o Getting feedback and coming up with report The feedback from the progress monitors o Improvement of communication between KMC midwives and maternity and hospital management o Improvement of written documents and guidelines toward KMC Komfo Anokye Teaching Hospital (KATH) and Suntres Government Hospital (SGH) in Kumasi, Ghana Three mother baby units in Kumasi KATH, SGH, and Kumasi south hospital (regional hospital) Currently there are two Mother and Baby kangaroo mother care units established by MASHAV in Kumasi Two pediatricians and two senior nurses o Now becoming experts and have trained hundreds of nurses all over Ghana Mrs. Regina Obeng has received the Neonatal Excellence Nursing Award at the international conference of nursing 2010 One unite in Kumasi South Hospital (2008) Another one at Suntreso Hospital (2009) Kumasi, Ghana is the capital of the most populous region in the country, the Ashanti region Population under 2 million, and is the second largest city in Ghana 28,000 babies are born and over 4,000 are low birth- weight, high risk or in need of special care. Hoping to establish Level 2 nurseries with KMC care in all 5 sub metro hospitals that will reduce the number of sick newborns in NICU at KATH by 50% Midwives in Kumasi has been trained and mothers are being educated on KMC for Low birth weight babies KATH is a teaching hospital that provides tertiary care The only neonatal facility in Kumasi (capital of Ghana) Had occupancy of over 200% (overly crowded) 24 hour in- patient service
77 cots, 4 functioning incubators, 2 overhead radiant heaters, 10 phototherapy units and 20 oxygen delivery outlets o With over ¾ babies sharing one radiant heater or incubator Not only trained KMC, but also the prevention of HIV/AIDs SGH is a district hospital and provide secondary care Continuous KMC is practiced at SGH as there is enough space for rooming in Neonatal care ward has 13 beds, and the KMC ward has 4 beds Mother- baby unit runs 24 hour service and is staffed by pediatrician and seven nurses Continue practicing KMC at home and bring their babies weekly follow up care till they attain a weigh of 3000g Emergency preparedness is low due to the poor transportation, lack of communication, lack of skills and poor staff Discharge and follow- up o Before discharging, KMC infants should gain weight but most hospital discharged the LBW infants within 72 hrs. Also, mother did not stay in hospital for long. o Also, 23 out of 38 hospitals stated that infants born there did not return for review or did not show up at the follow- up arrangements. Only 14 of the 23 hospitals have follow- up records or visits. o Home visits are not permit due to the cultural practices of restrictions on when and who is allowed to see the infants Result o 26/38 hospitals demonstrated sufficient progress with KMC implementation (total of 38 hospitals were visited, 33 district hospitals, 4 regional hospitals and one teaching hospital) o 66% of hospitals used a special record In Ghana, very few mothers knew about KMC at the beginning, they started to know after the nurse explained it to them. There are also some women who are not comfortable handling their young infants, and they would declined to practice KMC. But for those who practice KMC are willing to recommend it other mothers. Due to custom and belief, KMC are rarely practice outside. But, mothers were becoming more comfortable with practicing KMC outside their homes. In Ghana, the usual practice of carrying newborns for mothers is to wrap them against their back and not towards their chest.
Nurse Haajia Ayishatu Yakubu with a premature baby @ Suntreso Hospital s Mother and Baby Unit in Kumasi MBU unit at KATH One of the new neonatal clinics in Kumasi, Ghana that offers KMC training.
A medical professional with a staff member at the new neonatal clinics Patients in the Kangaroo Mother Care therapy room at Suntreso Hospital s Mother and Baby Unit
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