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This post was written by Dr. Shaun Morris a pediatric infectious disease specialist at Sick Kids Hospital in Toronto who developed the Maternal and Newborn Kit Baby Hero is funding.
As a pediatrician who has worked, studied, and conducted research in low income countries over the last decade, I am well aware of the burden of child mortality in these settings. At SickKids hospital in Toronto where I work as a pediatric infectious disease specialist, I have every possible medicine and technology at my disposal to provide the best possible care for my patients. However, when I work overseas, again and again I am struck by the fact that newborns, infants, and children, get sick and die from many things that at home would have been easily prevented or treated. The simple fact is that a baby who is born in Toronto has an overwhelming chance of a safe and healthy birth, infancy, and childhood. However, an identical baby who is born in rural Pakistan, Congo, or any number of other low income countries has a high likelihood of being born in a remote home, without any health care practitioners present, not being fully immunized, and having a high likelihood of getting sick and even dying from the most basic of conditions like pneumonia, diarrhea, or hypothermia.
I once attended a lecture by Stephen Lewis, the Canadian who served as the UN envoy for HIV/AIDS and something he said stuck with me forever. He said, ‘all of you sitting here in the audience have already won the only lottery that matters in life…you had the good fortune to be born in Canada’. The fact that where one is born is the biggest determinant of the likelihood of life or death seemed then, and continues to seem to me now, completely unacceptable and I have devoted my professional life to trying to improve the health of marginalized children in low income countries.
The good news is that huge strides have been made over the past decade in reducing under 5 year old mortality around the world. However, almost all of these gains have been in older children and now about 40% of all under 5 deaths occur in the first month of life. To make further strides in reducing global childhood mortality, we have to find ways to reduce newborn deaths. I’ve partnered with Baby Hero to bring a low cost and evidence based kit of simple but effective interventions to women in rural Pakistan. The kit contains a clean delivery kit to optimize sterility at the time of delivery even if in the home, a sterile blade to cut the umbilical cord which will minimize the incidence of neonatal tetanus, chlorhexidine lotion to apply to the umbilical stump and reduce the risk of severe infection, a sunflower oil emollient to maintain skin integrity (to reduce infection) and maintain body heat, a sticker that changes colour to allow a mother, even if illiterate, to be able to tell if her baby is too hot or cold and and mylar blanket with reusable heater to wrap a baby who is severely hypothermic. I believe that the kit, which when used at scale should cost less than $5, can reduce neonatal mortality by up to 40%. To show this, we are using a network of community health workers in Rahimyar Khan in Punjab Province, Pakistan, to deliver the kit to rural women in their third trimester of pregnancy along with education about its use. If our study is successful and does show a large reduction in mortality, we hope, with Baby Hero’s ongoing support, to scale up the kit to larger areas in Pakistan and eventually other countries around the world.
A Lady Health Worker in Rahim Yar Khan teaching - she was a very dynamic speaker who kept the attention of the group for well over an hour.
My first trip to Pakistan was in April of 2013. Though I’ve traveled to over 50 countries, I am still excited when first exiting an airport in a new place. I spent several days in Karachi, the largest city in the country, meeting and planning the study with collaborators from Aga Khan University and Maternal and Child Care Trust (MCCT), my two in-country partners. I then traveled to Rahimyar Khan, a town in southern Punjab on the edge of the Thar desert. The rural area around Rahimyar Khan is very poor with scattered villages in the dry parched land. With my Pakistani colleagues, I met with local community and political leaders who have provided support for our study and very importantly, I met with both Lady Health Workers and their managers. Lady Health Workers are an innovative program run by the Pakistani government that uses a cadre of female workers with minimal health training to visit homes with pregnant women and children to provide basic health care and education. In a setting where it’s very difficult for families to get themselves to healthcare, the Lady Health Care program brings healthcare to the families. While the people I met were intelligent, driven, and passionate about improving the health of their communities, it was clear that lack of resources remains a significant problem. I visited several primary health care centres which are devoted to providing basic obstetric and primary care to women and families and vividly recall the pharmacy in one which contained only a small handful of half-filled bottles of medicine and a delivery ‘suite’ that left no doubt why many women chose to deliver their newborn at home rather than at the health facility. What stands out most in my mind though is the overwhelming desire of all that I met to improve the health of their community. I believe that the neonatal kit can be a critically important tool to achieve this goal.
I will be returning to Rahimyar Khan in December and look forward to seeing my friends at the University, MCCT, and in Rahimyar Khan. Our plan is to begin rolling out the kit into the community in late December or early January and collect data for approximately a year and half to document the kits effectiveness. With the ongoing support of Baby Hero, I believe that we can make a huge difference to the health of women and their newborns in rural Pakistan and beyond!