Ten years ago, I was introduced to prematurity care in my last year of medical school as a medical intern. It started with a rotation in the neonatal care unit, NCU, at the University Teaching Hospital of Kigali (CHUK). It was the first time I saw a baby that weighed just 800 milligrams! To say the least, I was shocked. In the first week of my rotation, I was too terrified to even look at premature babies in the incubators and on infant warmers. I never got close enough to touch any of the babies. Yet, I was not alone. Even some mothers were afraid to touch their own babies. One mother pulled me to the side during rounds and whispered the unthinkable: she didn’t think her child was a “true baby.” She was among the mothers that stayed. Some abandoned their babies because they likened them to strange creatures. However, as the days passed by, my fears started fading away. The pediatrician in the unit appreciated my growing determination and trusted me with more responsibilities. This trust further boosted my confidence and gave me the courage to stand beside mothers as they emotionally struggled through the uncertainties that accompany preterm delivery. It further pushed me to learn and research more about the development of children with perinatal issues. Following the celebration of the World Prematurity Day that was observed last week, I want to remind us that having a premature baby–– a baby born before the 37th week of pregnancy––is much more common than we think. It happens in rural areas as it happens in urban areas and it is not just a modern phenomenon. The preeminent scientist, Albert Einstein, was born two months premature in 1879. It has been found that prematurity is the leading cause of neonatal mortality––dying during the first 28 days of life––and the second leading cause of all deaths in children under-five years of age worldwide. Unfortunately, sub-Saharan Africa and South Asia have the highest rate of premature births at 60%. Yet, this is where resources to take care of these babies are most lacking. In 2017, it was estimated that about 9% out of the 350,000 babies born every year in Rwanda are premature babies. The Ministry of Health, in collaboration with several development partners, is working tirelessly on neonatal mortality reduction initiatives. For example, all district hospitals are now equipped with modern neonatal care units (NCUs): thus, more and more premature babies are surviving beyond the neonatal period. Premature babies, especially those born very early, often have higher risks of having complicated medical problems such as inefficient body temperature control due to a lack of stored body fat, respiratory distress and lack of reflexes for sucking and swallowing, leading to feeding difficulties and malnutrition. These babies are also at high risk to contract infections. That is why these babies are admitted and taken care of in NCUs. However, prematurity complications do not end upon discharge from the NCUs. These babies face several challenges growing up. They are at risk of medical problems such as bronchopulmonary dysplasia (a chronic lung disease of preterm infants), iron deficiency anemia, vision (retinopathy of prematurity -a major cause of severe visual impairment or blindness) and hearing problems because the final stage of vision and hearing development occurs in the last 3 months of pregnancy. Other complications are neurodevelopmental challenges (speech and motor delays), feeding difficulties and malnutrition of all forms (undernutrition, wasting and stunting) and behavioral issues. If these complications are not addressed early enough, they can lead to disabilities. Clearly, providing medical care to premature babies requires a multidisciplinary pediatric specialty care such as developmental pediatrics, pediatric neurology, occupational therapy, physical therapy, nutrition, and pediatric psychology, ophthalmology, ENT, etc. Even if we lack many of the needed specialties to provide comprehensive follow-up care for preterm babies in Rwanda, I believe we can make a head start with the available general pediatric care. For example, the Ministry of Health together with Partners In Health/Inshuti Mu Buzima have been working on a structured and formal follow-up program - the Pediatric Development Clinic (PDC) in Eastern Province of Rwanda. PDC provides medical, nutritional and development screening to preterm and other “non-acute” medical conditions. Parents are taught different activities for early brain stimulation and meet with other parents of preterm babies. Of 2,000 children enrolled in PDC since April 2014, about 60% of them were premature babies. The clinic is run by nurses and social workers led by a general practitioner. Premature follow-up care needs to be integrated in the current healthcare system in Rwanda. Let us not forget to include support services for their parents and families as well. It is stressful to have a baby born before term. It is also both financially and morally challenging to get through the lengthy stay in NCUs and, once home, even harder to take care of these infants by random or on-demand follow-up visits by medical personnel and the caregivers. The writer is a General Practitioner with a master’s degree in Epidemiology and Biostatistics. She currently works as a clinical officer in the district hospitals of Rwinkwavu and Kirehe. The views expressed in this article are of the author.
