Tackling neonatal hypothermia in Uganda and Kenya

When placed in the Embrace Warmer, the premature baby's temperature reads 35.2 degrees Celsius. The 2-degree difference from normal body temperature is enough to kill a child. (Credit: Jennifer Zhu)

The Global Health Corps is a leadership development institute that aims to build the next generation of smart, innovative and compassionate global health leaders and mobilize the movement for health equity. All GHC fellows, partners and supporters are united in a common belief: health is a human right. Fellows work in pairs at placement organizations in Malawi, Zambia, Uganda, Rwanda and three cities in the United States to secure health equity and improve health systems. This is part of an occasional series in which fellows share their experiences.

By Jennifer Zhu special to Humanosphere

I tuck the lifelike doll in the Embrace Baby Wrap, securing the “infant” with the wrap’s Velcro straps – when one of the Ugandan health workers, peering over my shoulder, remarks, “If you wrap the baby like this, so quietly, the mamas will think their baby has died and call ahead to arrange a burial.”

He elaborates, “You have told us how we use this new technology, but I am saying to my brothers and sisters: We should also be educating the mamas what we are doing and why we are doing it.”

That new technology, the Embrace Baby Wrap, is a low-cost baby warmer developed as a class project at Stanford University. A group of graduate students created it as part of a challenge to design an intervention for neonatal hypothermia that costs less than 1 percent of the price of a state-of-the-art incubator. It is now being implemented in health facilities in low-resource areas of the world. I am training approximately 100 health-facility workers on the use of a technology to reduce neonatal hypothermia in Ugandan and Kenyan villages.

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The warmers are used in conjunction with kangaroo mother care, skin-to-skin contact between the mother and infant, the gold standard for helping infants maintain body temperature. The maker recommends using Embrace Warmers in situations where skin-to-skin isn’t an option: when a mother is in transit, caring for other children or twins and higher-order multiples, or recovering from a traumatic birth.

Hypothermia is one of the leading contributors to neonatal mortality worldwide. To help reach Millennium Development Goal 4 – reduce deaths in children under age 5 years by two-thirds from 1990 to 2015 – the U.N. Millennium Villages Project uses Embrace Warmers to prevent newborn deaths in developing countries, where 99 percent of neonatal deaths occur. The risk of hypothermia is high, even in the hot season of tropical climates such as those of equatorial Uganda and Kenya.

Ugandan midwife Khadijah Kyembe secures the infant with the Embrace baby wrap's Velcro straps. (Credit: Jennifer Zhu)

Ugandan midwife Khadijah Kyembe secures the infant with the Embrace baby wrap’s Velcro straps. (Credit: Jennifer Zhu)

The Embrace Warmer is like a tiny sleeping bag with a removable warm pack that is heated before insertion. It costs $200, less than 1 percent of the cost of a standard incubator. It replaces the use of hot water bottles that are difficult to regulate in temperature and can burn the babies. The rare incubator is much more expensive, consumes more power and requires constant electricity; the Embrace Warmer requires electricity for 30 minutes every four hours to reheat its warm pack.

At health centers without enough health workers – a widespread situation in developing countries – every helping hand is needed. Workers such as the grounds caretakers and operation-theater cleaners assist the lone midwife on duty in delivering babies.

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“I learned to deliver from an operation-theater cleaner,” one doctor shared with me.

The local nurses and doctors told us that these workers would likely help to operate the Embrace Warmers. We needed to train and engage more and different workers than we originally planned.

When on-the-ground workers are made to feel comfortable and empowered, when they know that their questions and opinions are valued, a wealth of information springs forth that helps to ensure the success of an intervention.

A month after the health workers were trained on use of the Embrace Warmers, I visited the health centers in Kenya and Uganda. Half of the health centers had used the Embrace Warmer. The health centers without grid power are on solar power, commonly lauded for its sustainability and long-term costs savings. But the health centers report it is often too cloudy to generate enough solar power to run the Embrace Warmer’s heater. Health workers are upfront about this challenge when asked, pushing Millennium Villages Project to look into connecting those health centers to grid power electricity.

Success builds upon success for an intervention’s implementation.

“We had a mama whose baby used the Baby Warmer. Later, in the village, they had a baby who was born premature. She [the mother whose baby had used the Baby Warmer]said, ‘At Kitwe Health Center, they have things, they will warm the baby.’” Ugandan midwife Juliette Uwamurera marvels, “And they sent the baby here.”

Zhu_Jen_PhotoJen Zhu is a health policy analyst. She served as Health Systems Quality Improvement Coordinator and a Global Health Corps fellow at U.N. Millennium Villages Project in Uganda. Follow her on Twitter at @jenqzhu

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