The Ministry of Health launched two key documents on the management of the condition on World Prematurity Day -an annual occasion to raise awareness on deliveries of premature children.
However, it turned out to be an opportunity for the country to acquire a life-saving drug for preterm babies at a subsidised cost.
From Ksh1,500 initial cost of Caffeine Citrate to Ksh400 per one ampule - a single dosage - will be a breather for the country where neonatal deaths account for 66 per cent of total infant mortality and 51 per cent of total under-five fatalities.
Caffeine Citrate, a product of ethypharm, a UK-founded pharmaceutical manufacturer, is effective and improves the chances of survival for premature babies at 18–21 months of first administration, according to Dr. Patrick Amoth, the Ministry of Health's acting director general of health.
"There is, therefore, a need for reinvigorated commitment to enable the country to meet the Sustainable Development Goals (SDGs) neonatal mortality rate target of 12 deaths per 1,000 live births by 2030," Dr Amoth stated during the launch of the Kangaroo Mother Care Clinical Implementation guidelines and the Management of Apnoea of Prematurity National Guidelines, 2023, in Wote, Makueni County.
He lauded the working relationship between the government and various partners, especially in the health sector as enablers towards addressing health challenges facing the country.
Amoth revealed that most neonatal deaths, about 75 percent occur during the first week of life, and therefore the announcement of a reduced cost of caffeine Citrate, comes at an opportune time.
"Majority of these deaths can be prevented and treated by implementing scalable, high-impact, evidence-based. Interventions," he said in relation to the increased coverage of skilled delivery in Kenya.
It turns out that this year has been the worst period for babies born prematurely, with infant fatalities increasing from 33.23 per cent in 2022 to 37.26 per cent this year.
In 2021, infant deaths stood at 32.82 per cent.
Janet Karemi, head of the Newborn and Child Health Division at the Ministry of Health revealed that this year, the country recorded a 4 per cent rise in infant deaths at 37.26 per cent from 33.23 per cent in 2022 and 4.4 per cent from the year 2021 when it stood at 32.82 per cent.
“In Kenya, approximately 134, 000 babies are born prematurely every year. Unfortunately, a significant number of these babies die due to complications of prematurity, while others face lifelong disability,” she said during a media workshop hosted by a number of civil society organisations under the Scaling Up Nutrition Civil Society Alliance (SUN-CSA).
Karemi also named five counties where the burden of infant deaths due to premature births are domiciled as Elgeyo Marakwet, leading with 11.2 per cent, followed by Kilifi (9.7 per cent, Samburu (8.9 per cent), Kirinyaga (8.7 per cent) and Nyeri (7.9 per cent).
Asked what could be the causes, she said this calls for research to determine the overriding reason.
“However, we have a high prevalence of young girls who become mothers too early in most of these five counties,” she said, citing this could be one of the reasons, but requires targeted evidence to pinpoint the real causes.
The leading possible causes of neonatal deaths among preterm or low birth weight infants, according to Karemi are birth asphyxia, neonatal sepsis, respiratory distress and hypothermia. This is also corroborated by several studies including the KDHS, 2022 which was released in July this year.
“Lack of check-ups for pregnancy complications, unskilled antenatal care provision and lack of tetanus injection were associated with neonatal mortality in the country,” she said, noting that with enhanced interventions for preventing and treating prematurity, preterm babies in Kenya can be saved in a number of simple ways.
Those behind the Caffeine Citrate revealed that frequent dosages administered on a daily basis reduce apnoeic episodes by 50 per cent when given within the first three days after birth.
According to Ethypharm's General manager -of Middle East and North Africa, Rob Bruchet Caffeine Citrate will make a huge difference in the management of Apnoea of Prematurity.
"The partnership therefore will help make a difference with Ethypharm special access pricing, after we realized that price was a huge barrier," he said.
Apnoea of prematurity is a condition where pre-term babies stop breathing for more than 20 seconds, and administration of Caffeine Citrate therefore is meant to stimulate the infant's memory to breathe.
In this case, infants have a slow heart rate accompanied by low oxygen levels.
"The more premature the baby is, the greater the chances of apnoea are," Ethypharm Key account manager for Kenya, Kirkland Dingli Magwilu said, noting that the beneficial effects of caffeine citrate are fewer ventilator days, reduced incidence of bronchopulmonary dysplasia, and improved neurodevelopmental outcomes.
Apnoea of prematurity is mainly caused by immaturity of the brain, while factors like infections, and temperature problems can result in apnoea.
"Babies who develop apnoea of prematurity are at risk for complications and death," he said, asserting that the earlier the treatment, the higher the chances of survival.
The treatment is administered for two weeks and every day they are given one vial.
Caffeine Citrate has been recommended by the World Health Organization (WHO) for the short-term treatment of apnoea of prematurity in infants between 28 and less than 33 weeks gestational age
However, because of the prohibitive cost, many households have not been able to have their children treated, and hence sometimes, they treat it as a cultural issue, leading to premature deaths.
Clinton Health Access Initiative (CHAI)stepped in and negotiated a deal with the manufacturers, and this will see the commodity supplied to Kenya Medical Supplies Agency (KEMSA) at a subsidized rate.
According to CHAI Deputy Director, Rosemary Kihoto, the organisation has negotiated for a price reduction of Caffeine Citrate.
“CHAI has supported and negotiated for over 70 per cent reduction in access price for caffeine citrate which was initially stocked at Sh1,500 but now it will be accessed with only Sh400," she said.
Initially, the price was a barrier due to access but now more facilities can afford to buy more quantities,” said Kihoto.
Clinton Health Initiative (CHAI) and Ethypharm also donated Shs 13.5 Caffeine Citrate to Kenya Medical Supplies (KEMSA) to strengthen access.
According to Ethypharm Regional Manager, Northern Sub-Saharan Africa, Reuben Sigey, the use of evidence-based, cost-effective, and low-technology therapeutics, like caffeine citrate, is desirable to augment the limited respiratory support in local settings.
“Ethypharm will work with our local distributor Laborex Kenya to ensure that products are distributed with the highest quality and standards to ensure that people of Kenya benefit from the partnership,” he said.
Sigey believes that as access improves more volumes will be required and therefore the prices may go down even lower.
“Caffeine citrate is as effective as aminophylline that was previously used but is safer and easier to administer and has better therapeutic properties
"It is therefore preferred for the treatment of apnea of prematurity," he said.
Betty Wariari Clinton Health initiative says that with inadequate staff to manage newborn units’ the development of the guidelines for the management of Apnoea of Prematurity using Caffeine Citrate, Continuous Positive Airway Pressure (CPAP) and pulse oximetry will tremendously help to reduce neonatal mortalities.
She explains that Caffeine Citrate use and availability will really help in reducing the burden of work in newborn units since most of the time you find that the number of neonates in newborn units requiring monitoring overwhelms the neonatal nurses on duty to closely monitor their breathing patterns.
“With the guideline launched a strong foundation has been laid to increase investment towards caffeine citrate commodity,” she said.
Despite Kenya putting in place a national guideline on the management of Apnoea of prematurity in line with the 2022 World Health Organization recommendation which was launched alongside updated Kangaroo in an event to mark World Prematurity Day in Makueni County access and affordability of commodities still remain a big challenge. According to Makueni County Governor, Mutula Kilonzo Junior, the prohibitive cost of medical equipment and commodities hinders neonatal care.
A total of 30, 000 ampules were donated, with CHAI giving 20,000, while Ethypharm rewarded health facilities with an additional 10,000 ampules of the caffeine citrate and essential equipment for use in newborn units, such as syringe pumps and pulse oximeters.
