Why a newborn is more likely to die in Nairobi than in rural areas

Tuesday July 16 2019

A graphic showing neonatal deaths per 1,000 live births between 2011 and 2018. GRAPHIC | THE EASTAFRICAN


The relationship between health resources and neonatal deaths in East Africa’s urban centres compared with rural areas had left researchers baffled.

A report by the Kenya Medical Research Institute Wellcome Trust shows that Kenya’s capital Nairobi, which holds a tenth of the country’s health resources — healthcare workers and facilities — records one of the country’s highest numbers of deaths among newborns.

At 39 deaths per 1,000 live births, Nairobi’s rate is much more than the national average of 22 deaths in 1,000 births, as reported by the Kenya Demographic Health Survey.

Tanzania’s rate stands at 24 deaths per 1,000 live births in the rural areas and 44 in urban areas, according to the country’s demo-graphic survey. Uganda’s rate is 27 deaths per 1,000 live births but Kampala’s is 29 deaths per 1,000 live births.


Nairobi reports grimmer statistics than some of the 15 counties that were labelled by the United Nations as the most dangerous counties to give birth in. For example, Migori County records a neonatal mortality of 19 per 1,000 births.


About 132,000 children are born in Nairobi, and about a fifth of these babies (24,000) will be seriously ill to the point of needing care. However, almost half of the babies (44 per cent) who need this care will not have access to a hospital. The other 56 per cent (13,440) will get to the hospital but the quality of care is questionable.

The authors state: “This means about 44 per cent of all seriously ill newborns are given care in a facility that is not suitable at all or do not reach a facility at all — perhaps helping to explain Nairobi’s high neonatal mortality.”

Dr David Gathara, the lead author of the paper, told The EastAfrican that the number is unacceptably high, blaming it on the low focus on the neonatal period — the first 28 days of a child’s life.

The study painted a dark picture for children whose mothers can only afford to seek care in public hospitals: Only 33 hospitals in the city are able to offer care to the babies, but “of these only four are public though they provide 71 per cent of all existing inpatient neonatal care.”

The highest number of births and episodes of serious neonatal illness for the children, Dr Gathara noted in his paper, took place in the densely populated, low-income areas of Nairobi.


According to Prof Rachel Musoke of the University of Nairobi’s Paediatric Department, neonates are a delicate lot. “At that stage, they cannot regulate their own body temperature, so they lose all the water through the skin and die of dehydration; they cannot eat on their own so food has to be given through a pipe; they pick diseases very fast,” she said.

The neonates need to be in electric cots (incubators) that keep the temperature and humidity within survival range to ward off dehydration.

The babies also “forget to breathe” because their brains are not fully developed to co-ordinate these functions. They turn blue, start foaming and a nurse has to be present at that very moment to “remind the baby to breathe.”

“They are stimulated by touching, and sometimes resuscitated if they do not remember to breathe,” Prof Musoke added.

The quality of care at hospitals was judged based on infrastructure and healthcare workers’ ability to keep a child alive.

Dr Gathara asked: “Are they able to take care of a pregnant woman who is just about to deliver? Are they able to keep the baby warm? Can they feed it? When the babies get sick, can they look after them?”

Dr Gathara found that almost 40 per cent of seriously sick babies in Nairobi were admitted to hospitals with low knowledge scores.


The report found the situation in Mulago Hospital, Uganda’s largest referral hospital so desperate that there was one nurse overseeing labour, delivery and neonatal wards. These are all critical sections in the maternal health whose skill sets and needs are specialised and need constant monitoring.

A 2018 report by the child organisation Save the Children and the Ministry of Health of Uganda found that 29 per cent of the deaths of babies under five were attributed to hypothermia (cold).

However, amid all the gloom and dread, the countries are working on some solutions.

Uganda has put more emphasis on kangaroo mother care in referral hospitals such as Mulago, a technique in which the mother places the baby in their bosom for warmth.

In Kenya, experts recommend the upgrading of health facilities so they can provide standard neonatal care as well as ensure that the few that can offer the care are supported.

Tanzania has partnered with organisations such as Korea International Co-operation Agency to strengthen its referral system to ensure women whose children are likely to risk their babies such as those who are hypertensive have access to instant care.