How 'Kangaroo' Care Saves Premature Babies In Senegal

First established in Colombia, kangaroo care for underweight babies relies on constant mother-child contact and avoids costs and complications of incubators that rarely arrive in Africa.

Twin boys strapped to their grandmother’s chest in Malawi.
Twin boys strapped to their grandmother’s chest in Malawi.
Rémi Barroux

DAKAR — Three moms are occupying the cream-colored room of the Albert-Royer Children Hospital, in the Fann neighborhood of Senegal's capital. Each is caring for her newborn of little more than four pounds. Resting skin-to-skin, the contact between mother and child provides the warmth necessary to treat premature babies. This is called the "kangaroo method."

As she is cuddling her little Adama, one mother named Comba Fall wears a special homemade T-shirt that has a slit to let her son's head out. The 23-year-old mom has been there for four days, after realizing that her son, born during the eighth month of pregnancy, was losing weight. He was only 3.5 pounds at birth. But so far, the kangaroo method is working: Adama is gaining around 0.3 ounce per day.

From their beds, the two other mothers report similar progress, and all are expected to soon be allowed to go back home.

"We have to be sure that the child is regaining weight and that the mother understands the instructions, that she breastfeeds her baby every two or three hours, because the child is sleeping most of the time and doesn't indicate when they need to eat," explains Fall Aida, who heads this special Kangaroo Unit in the Dakar hospital.

Three nurses and a pediatrician are in charge of the service. Issa Niang, 22, is set to go back home. Her child weighed 3.7 pounds at birth. "He will stay in kangaroo until he will weigh 6.6 pounds, the mum will have to carry him strapped to her until that moment," Aida adds.

The Albert-Boyer hospital was created in 1982 with Canadian aid, but this service was inaugurated in 2011 and it has already helped care for 181 children. The first baby the Center took charge of was from Tuba, around 125 miles east of Dakar. Born in the sixth month of pregnancy, he weighed only 28 ounces at birth and was declared "non-viable." A few months later, the child went home, healthy.

The Colombian pediatric team of Edgar Rey and Hector Martinez inaugurated this method for the first time in 1983, in order to treat preterm newborns. It represents an alternative to cumbersome and expensive incubators, a solution particularly welcome in countries where malnutrition risks weight loss for already premature babies.

Emotional advantages

Supported by the World Health Organization (WHO), this technique helps fight against infections and gives a "thermal protection" to the babies. It also allows for mothers to breast-feed their children and it is positive for the newborns' development as "emotional connections" are easier to establish.

"Our incubators could not solve all the problems," explains Haby Signaté, Head of the Hospital Neonatal Unit. "The whole concept is based on the mothers. At the beginning, many of them are afraid, and it goes against the custom of mothers here carrying the babies on their back. But the kangaroo method is reliable and affordable."

The model's simplicity is the secret of its success. It was borrowed from the Kangaroo baby and its development inside a marsupial pouch, that typically lasts for 250 days. "We decided to expand the kangaroo to a national scale," declared Dr. Bocar Daff, Head of Reproduction Health and Child Survive to the Senegalese Health Ministry. "Since we lack the means, it is a priority. We have ten units like the Albert-Boyer, but it is not enough." With the help of UNICEF — United Nations Children Fund — pediatricians and nurses are trained in the method.

Neonatal health troubles are still significant in Senegal, with the rate of assisted labor by qualified staff at just 65% in 2012. "All the others are giving birth helped by traditional birth attendants or grandmothers," says Nestor Pepe Azadegbe, Health Advisor for the United Nations Population Fund. "In 2000, this rate was 47%, so the evolution is positive."

To support Senegalese health policy, France contributes to the Muskoka Health Fund, which help 11 countries in Western Africa to decrease mother and child mortality, as part of the Millennium Development Goals. "The international help represents a third of the health expenditures in Senegal," notes Daff.

The beauty of the kangaroo method, notes Nestor Pepe Azandegbe, is that it is innovation that eventually can arrive at zero fixed cost.

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Iran-Saudi Arabia Rivalry May Be Set To Ease, Or Get Much Worse

The Saudis may be awaiting the outcome of Iran's nuclear talks with the West, to see whether Tehran will moderate its regional policies, or lash out like never before.

Military parade in Tehran, Iran, on Oct. 3


LONDON — The Iranian Foreign Ministry spokesman Saeed Khatibzadeh said earlier this month that Iranian and Saudi negotiators had so far had four rounds of "continuous" talks, though both sides had agreed to keep them private. The talks are to ease fraught relations between Iran's radical Shia regime and the Saudi kingdom, a key Western ally in the Middle East.

Iran's Foreign Minister Hossein Amirabdollahian has said that the talks were going in the right direction, while an Iranian trade official was recently hopeful these might even allow trade opportunities for Iranian businessmen in Saudi Arabia. As the broadcaster France 24 observed separately, it will take more than positive signals to heal a five-year-rift and decades of mutual suspicions.

Agence France-Presse news agency, meanwhile, has cited an unnamed French diplomat as saying that Saudi Arabia wants to end its costly discord with Tehran. The sides may already have agreed to reopen consular offices. For Saudi Arabia, the costs include its war on Iran-backed Houthis rebels fighting an UN-recognized government in next-door Yemen.

The role of the nuclear pact

Bilateral relations were severed in January 2016, after regime militiamen stormed the Saudi embassy in Tehran. Amirabdollahian was then the deputy foreign minister for Arab affairs. In 2019, he told the website Iranian Diplomacy that Saudi Arabia had taken measures vis-a-vis Iran's nuclear pact with the world powers.

It's unlikely Ali Khamenei will tolerate the Saudi kingdom's rising power in the region.

He said "the Saudis' insane conduct toward [the pact] led them to conclude that they must prevent [its implementation] in a peaceful environment ... I think the Saudis are quite deluded, and their delusion consists in thinking that Trump is an opportunity for them to place themselves on the path of conflict with the Islamic Republic while relying on Trump." He meant the administration led by the U.S. President Donald J.Trump, which was hostile to Iran's regime. This, he said, "is not how we view Saudi Arabia. I think Yemen should have been a big lesson for the Saudis."

The minister was effectively admitting the Houthis were the Islamic Republic's tool for getting back at Saudi Arabia.

Yet in the past two years, both sides have taken steps to improve relations, without firm results as yet. Nor is the situation likely to change this time.

Photo of Iranian Supreme Leader Ali Khamenei in 2020

Iranian Supreme Leader Ali Khamenei in 2020


Riyadh's warming relations with Israel

Iran's former ambassador in Lebanon, Ahmad Dastmalchian, told the ILNA news agency in Tehran that Saudi Arabia is doing Israel's bidding in the region, and has "entrusted its national security, and life and death to Tel Aviv." Riyadh, he said, had been financing a good many "security and political projects in the region," or acting as a "logistical supplier."

The United States, said Dastmalchian, has "in turn tried to provide intelligence and security backing, while Israel has simply followed its own interests in all this."

Furthermore, it seems unlikely Iran's Supreme Leader Ali Khamenei will tolerate, even in this weak period of his leadership, the kingdom's rising power in the region and beyond, and especially its financial clout. He is usually disparaging when he speaks of Riyadh's princely rulers. In 2017, he compared them to "dairy cows," saying, "the idiots think that by giving money and aid, they can attract the goodwill of Islam's enemies."

Iranian regime officials are hopeful of moving toward better diplomatic ties and a reopening of embassies. Yet the balance of power between the sides began to change in Riyadh's favor years ago. For the kingdom's power has shifted from relying mostly on arms, to economic and political clout. The countries might have had peaceful relations before in considerably quieter, and more equitable, conditions than today's acute clash of interests.

If nuclear talks break down, Iran's regime may become more aggressive.

Beyond this, the Abraham Accord or reconciliation of Arab states and Israel has been possible thanks to the green light that the Saudis gave their regional partners, and it is a considerable political and ideological defeat for the Islamic Republic.

Assuming all Houthis follow Tehran's instructions — and they may not — improved ties may curb attacks on Saudi interests and aid its economy. Tehran will also benefit from no longer having to support them. Unlike Iran's regime, the Saudis are not pressed for cash or resources and could even offer the Houthis a better deal. Presently, they may consider it more convenient to keep the softer approach toward Tehran.

For if nuclear talks with the West break down, Iran's regime may become more aggressive, and as experience has shown, tensions often prompt a renewal of missile or drone attacks on the Saudis, on tankers and on foreign shipping. Riyadh must have a way of keeping the Tehran regime quiet, in a distinctly unquiet time.

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