It’s official! skin to skin care saves lives

https://www.nejm.org/doi/full/10.1056/NEJMoa2026486 takes you to the full text of this 2021 publication from WHO comparing survival data of low birth weight infants nursed skin to skin from birth with a cohort who only received a couple of hours a day of skin to skin care. The trial had to be cut short because the babies in the control group (couple of hours a day) had a significantly higher risk of dying than the babies in the intervention group (around 17 hours a day skin to skin).

Keeping babies warm workshop, Neonatal Care Course, Mutengene, Cameroon. June 2021

Grace gathered 9 of the trained instructors in Cameroon this month for a Neonatal Care Course which trained 36 more healthcare workers in the care of the newborn baby in the first 28 days of life. Quite a feat in a country battling with Covid and political unrest. Immensely rewarding for NICHE volunteers and trustees to see the programme up and running without much direction from us. Julia did try to “drop in” to some of the sessions via zoom on day 2 but the internet connection was so bad that, in the end, she gave up and let the Cameroonian faculty get on with it themselves. There’s only so much one can do remotely.

Today is International women’s day

Dr Alison Earley

It’s a day for dressing up in much of the world, a day to celebrate the work women do to make the world go round, a day of empowerment. The picture here is of Cameroonian women on International Women’s Day in 2018, learning how to resuscitate babies dressed in their International Women’s Day material that they make into powerfully beautiful dresses every year. We should make more of it in the UK really.

There are many achievements to celebrate on International Women’s Day, but we mustn’t forget that in resource poor areas of the world, maternal mortality (death related to pregnancy and childbirth) is still 5 – 10 times higher than in richer countries.

Many mothers still give birth in unclean or unsafe places, and without skilled help or adequate facilities.   This has a direct result on the survival of their babies; two of the leading causes of neonatal mortality are infection and intra-partum related events.

Education for healthcare workers and sustainable improvements in maternal and newborn care are the key to improving this situation.   NICHE International has a mission to improve the care of newborn babies, by the training we give and by supporting nurses, doctors and midwives to maintain their skills and improve the care they give to mothers and babies.

Training (predominantly female) nurses and midwives to be instructors on the Neonatal Care Course (NCC) empowers them to “Choose to Challenge” and make changes to their own healthcare systems from the bottom up.

Zooming to Cameroon

Local Cameroonian instructors, who are now organising their own Newborn Care Courses, ran an NCC last week in Yaoundé, Cameroon.  Some NICHE Instructors joined them for parts of the course via zoom from UK, to try out the technology and assess the feasibility of remote training.

We were able, remotely, to:

1. Demonstrate how to run a simulation (this was management of a baby having fits).  NICHE Instructors from their homes in London and N. Ireland did this on zoom at the request of Cameroonian Instructors who watched.

2. Deliver one of the lectures on the NCC course via zoom

3. Join the faculty meetings in Cameroon at the end of each day.

4. Join the candidates for certificate presentation at the end of the course.

This was a useful exercise as we are thinking about the practicalities of training online, in particular delivering ‘Instructor Development Days’ for Cameroonian NCC Instructors, which before the pandemic, we had hoped to be able to do in person in November.

There are some technological improvements to make, but generally it was successful.

It was a pleasure to see our Cameroonian colleagues, who keep going despite pandemic and political difficulties.

Some comments from candidates on the course:

  • The training was an impacting one with lots of skills and knowledge acquired.  I could have wish that all health personnel around the world be train if possible to augment care of neonates.
  • I am confident now that I can take care of a newborn very well as compare to what i was doing in my station, especially resuscitating asphyxiated babies immediately after delivery.

Universal health coverage (UHC)

“Universal Health Coverage (UHC) means that all people can access quality essential health services, without having to suffer financial hardship to pay for health care.”  Says the World Bank which teamed up with WHO in 2017 to monitor progress with this target. https://www.worldbank.org/en/topic/health/publication/universal-health-coverage-study-series

“Each year, close to 100 million people are being pushed into extreme poverty because of health expenses, and 800 million spend more than ten percent of their household budgets on health care. Achieving UHC is not just about better health outcomes. The overarching goal of the Sustainable Development Goals (SDGs)–ending extreme poverty–will remain out of reach without UHC.” [World Bank]

Achieving UHC is one of the targets the nations of the world set when adopting the Sustainable Development Goals in 2015 but, despite this, at least half the world’s population has to pay for some or all essential health services.  People in the poorest countries are the worst affected.

Colleagues in Cameroon, who have been trained by NICHE International to teach a Neonatal Care Course, recently taught this course in Yaoundé.  An important part of the course is the teaching of skin to skin mother care, also called kangaroo care.  This has many advantages and is advocated by WHO as a way of promoting the healthy survival of babies.

Premature baby being kept warm sustainably

Candidates on the course recognised these advantages -see comment below from one candidate.

  • I must comment I learnt a lot on demonstration of S2SMC (skin to skin mothercare) which i thought i could do it but just realised I was far below standard.  This training is so empowering.  Keep up.

However, a problem that became clear during the course, is that one of the hospitals in Yaoundé asks parents for payment whenever a baby is nursed in an incubator.  The hospital management is therefore unwilling for their nurses to introduce skin to skin mother care, as when a baby is nursed with his/her mother, the hospital does not get this payment.  This is despite the fact that skin to skin care is usually better and safer than incubator care, particularly in poorer countries.

There is still much to do to advocate for safe basic healthcare for newborn babies.

Read more on UHC at:

https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)

Feedback from mboppi course

“This course was very resourceful, I have gained more skills and will transmit the knowledge gained to my colleagues so that together we can improve the neonatal care outcome in Cameroon

Grace and Dr Ngu Ernest, paediatrician in Douala, have just completed a Neonatal Care Course in Mboppi Hospital, one of the Cameroon Baptist Convention Heath Services institutions. 21 candidates attended and all passed the course. The programme used was the ALSG/MCAI one that NICHE instructors have used in the past. It was nice to see that Grace had also included an update for everyone on presentations from the 2nd African Neonatal Nurses Conference in Kenya that she attended with NICHE’s help in November 2019. We are proud to be associated with such an energetic campaigner for newborn care.

Presentations were wonderful and work stations so interesting

Care of the newborn in Cameroon will improve greatly if health care workers are knowledgeable and only such training can help.  I wish such trainings could be open to other health facilities for awareness

I am more and well equip now than before on how to care for baby’s who will not live long

More time should be allocated for workshops

Care of newborn in CBCHS [Cameroon Baptist Convention Health Services] is very high than in other services, so I plead if this course can be extended out to other facilities, we will actually reduce the death rate of neonate in Cameroon

The practical were very educative and interesting

See the blog post below for some images from the recent course delivered by 6 Cameroonian instructors with no input from UK-based NICHE instructors. New definition of sustainability – the excitement experienced when one puts oneself out of a job.

A socially distanced neonatal care course in douala, cameroon

Covid has not deterred our Cameroonian colleagues from running their independent Neonatal Care Courses. Here they are, working hard at the Mboppi Baptist Hospital in Douala this month.

Covid has highlighted the importance of training local instructors. While we have to sit on our hands in the UK, unable to travel to teach, the instructors we have already trained in west Africa are busy cascading best neonatal practice and continuing our joint mission of reducing neonatal mortality.

1m+ social distancing in the classroom keeps the learners as safe as possible.

Credit to Grace and her team for keeping the programme going during this challenging period. An inspiration to us all.

Breastfeeding workshop

The Neonatal Care Course (NCC) is an educationally robust product.  We teach about the four main areas that the World Health Organisation identifies as contributing maximally to neonatal mortality rates: resuscitation at birth, early breast-feeding, keeping babies warm and early recognition and management of sepsis.  https://www.who.int/maternal_child_adolescent/topics/newborn/enap_consultation/en/).  Our feedback forms show increased confidence of learners in all 4 of these areas. Increased clinical confidence correlates with increased performance over time.

Here is Grace, a one time NCC learner and now in-country NICHE champion and convener of their own independent NCCs, delivering a workshop on breastfeeding to local midwives.  This is what empowerment of local health professionals does.  This is our legacy and we are proud of it and very grateful to all who donate time, money and expertise to our charity.

Cameroon Instructor Development Days

We have been busy putting together suitable programmes for our on-going development and support of the local instructors in both Cameroon and Liberia.  We have been asked by Grace and her team in Cameroon to return there once a year for the next 3 years to take them from Step 8 of the “10-steps to sustainability” plan to Step 10 (where they can train their own instructors).  We are actively fundraising for this project at the moment if anyone wants to help out – https://www.nicheinternational.org.uk/ways-to-donate/.

We have begun to put together a tentative programme for a 2-day instructor development course, termed CIDD, which will be delivered in-country to ensure instructors are up to date in both the content and delivery of their provider course, the Neonatal Care Course (NCC), and to furnish them with the skills needed to keep themselves developing professionally after 2023.

Click here for a preview.

Independent Neonatal Care Course

Midwives in Bamenda this week (North West region of Cameroon) learning how to tie a “Kalafong” wrap for skin-to-skin mother care as part of their 2 day Neonatal Care Course.  22 learners with 100% pass rate in a town which is at the centre of the current sociopolitical unrest in Cameroon and to which UK instructors are no longer allowed to travel.  Hats off to Grace and her team for running their first independent course and thanks to our partners, the Cameroon Baptist Convention Health Services, for their support and encouragement.

United Nations Convention on the Rights of the Child

The rights of children across the world are enshrined in the United Nations Convention on the Rights of the Child, or UNCRC, signed by all UN members except the USA.  The Convention has 54 articles that cover all aspects of a child’s life and set out the civil, political, economic, social and cultural rights that all children everywhere are entitled to. It also explains how adults and governments must work together to make sure all children can enjoy all their rights.

Every child has rights, whatever their ethnicity, gender, religion, language, abilities or any other status.

You can read more about it at https://www.unicef.org.uk/what-we-do/un-convention-child-rights/.

The UN rights of the child are often violated when families are in situations of conflict.  In particular articles 19 (protection from violence, abuse and neglect) and article 38 (war and armed conflicts) from the UN Convention, are relevant in this regard.

Over the last 2 years, while NICHE has been working in Cameroon, West Africa, we have seen how civil unrest there has affected patients, and indeed, hear firsthand from health professionals who continue to try to care for them.

A young doctor who attended one of our Newborn Care training courses earlier this year in Cameroon, has recently written about the direct effects on children’s health that she has witnessed.

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Over the past three years, the English-speaking North West and South West Regions of Cameroon have been affected by civil unrest.  Since the crisis started in October 2016 following a strike action by teacher and lawyer unions, it has escalated to an armed conflict. There has been heavy military deployment to the regions and violent attacks by the opposing forces in urban and rural areas, leading to disruption of activities in communities, displacement from homes, and loss of property and lives. Education, business and healthcare are some of the most directly hit activities in the different communities affected by the conflict. Its adverse effects are numerous, including difficulty in providing and accessing proper health care facilities, causing diseases, which had been under control, to regain grounds, become virulent and lead to increasing levels of disability and death.

Working in the Pediatric Unit of the Bamenda Regional Hospital over the past months, we have witnessed this centre, which is the only very accessible reference centre of the North West Region, struggle to manage the current challenges despite the continuing conflict. We have seen a rise in the severity of epidemic diseases like Malaria and Dysenteric illnesses, seen by the 198 cases of malaria treated from January to August 2019 as to the 168 treated in the same duration in 2018. In 2018 alone, 119 cases of meningitis were managed in our health facility.  Added to these, are diseases which are now poorly managed due to lack of health facilities and personnel in the surrounding villages, notably Tuberculosis, HIV/AIDS, Sickle cell Disease, Pneumonia, and  Severe Malnutrition.

Children are the most affected, with two out of every five inhabitants of our Region being under the age of 15 years old. As the conflict continues, access to hospitals and other health centres from surrounding villages remains very difficult for these populations notably the children. By the time they successfully arrive at facilities like ours, it is either too late and they expire, or they end up disabled.

The lack of adequate health infrastructure and personnel especially in the periphery of Bamenda and surrounding villages has also adversely affected vaccination coverage for children in these areas. We are therefore exposed to a high risk that vaccine-preventable diseases may resurface, with catastrophic effects on the children. We have unfortunately had cases of children as old as 1 year who haven’t received any vaccines since they were born in the bushes to displaced mothers.

On a final note, we have been witnessing an alarming rise in cases of sexual abuse on children. The numbers are on the rise, thereby increasing the risk of sexually transmitted disease infections as well as additional psychological trauma, which would both have disastrous consequences.

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The current crisis in Cameroon is complicated.  Good resources to look at if you want to know the timeline of the conflict are:

https://africanarguments.org/2019/08/13/cameroon-crisis-three-deepening-divides/ and

https://www.bbc.co.uk/news/av/world-africa-44459488/cameroon-crisis-explained which has links to up to date information like the recent release of the opposition leader from prison and the current peace plan.