Born too soon: Inside Siaya's race to save preterm babies

At Siaya County Referral Hospital, the usually busy corridors are unusually quiet. Only a handful of people sit scattered across the waiting area. The nationwide medics’ strike has brought most hospital activities to a near standstill, creating an eerie calm in a facility that would ordinarily be filled with patients, relatives and health workers.

But behind the doors of the maternity, newborn and Kangaroo Mother Care units, life continues.

This is where 24-year-old Emily Achieng Omondi found herself after going into premature labor and giving birth to her first child at 26 weeks. Her daughter, Kayla, weighed just 900 grams; four months later, she weighs 3.8 kilograms, numbers that, for Emily, represent survival.

"I thank God that my baby was alive," she says.

Emily's pregnancy had not started as a crisis. She had been diagnosed with ulcers about six months in and treated, and was reassured that the H. pylori medication would not affect her pregnancy. Then, in February 2025, severe, sharp stomach pain set in for about three days. She ignored it at first, hoping it would pass. Instead, it became unbearable.

"I was vomiting and could hardly walk," she says.

She sought help at Sigomere Sub-County Hospital, where she was admitted, medicated, and put on a drip. On the fourth day, she says, she was told the health workers were waiting for her to miscarry.

"I was devastated. I could not imagine them waiting for me and my baby to die," she says.

A concerned nurse called an ambulance and arranged her transfer to Siaya County Referral Hospital. Emily arrived around midnight, bleeding and in labor, and gave birth to a baby girl two hours later.

"In the midst of all the confusion, the doctors told me I had given birth to a girl. It was not easy. I had given birth at 26 weeks," she says.

Kayla was rushed to the newborn unit while Emily recovered on the ward, visiting daily to monitor her progress. Mother and daughter later moved to the Kangaroo Mother Care unit, where skin-to-skin contact, frequent interaction, and feeding helped Kayla gain weight; she was discharged a week later at 1.8 kilograms.

"Seeing my baby alive gave me the motivation to keep taking care of her," Emily says.

Community health promoters continued checking on mother and baby after discharge. Today, at four months, Kayla weighs 3.8 kilograms, a milestone Emily does not take for granted. Her message to other mothers with premature babies: "Do not give up."

Next to her sits Jacinter Auma, 28, a mother of four known affectionately as Mama Glen, whose journey was marked by repeated warnings that her baby might not survive. Her ordeal began at Ting'are Health Center, before she was referred to Sigomere Sub-County Hospital and admitted for four days. She was preparing to leave when, at about 4 pm, severe labor pains began, and she alerted a health worker but felt dismissed.

"The health worker became angry when I continued to complain. She told me to relax, saying my pregnancy was too small, not worth the fuss, and that it wasn't time yet," she recalls.

She was also told that even if she delivered, the baby was too small to survive. But tests showed she was seven centimetres dilated. An ambulance was called, and she arrived at Siaya County Referral Hospital about 8.30 pm, giving birth soon after to a baby boy weighing about 950 grams, by her account.

"I was in pain and hadn't even seen my baby. I had no idea what I had given birth to," she says.

The baby was rushed to the nursery, and the weeks that followed were an emotional rollercoaster.

"Sometimes I would be called and told my baby wasn't breathing, or that he wouldn't make it through the night," she says.

She watched her baby supported with oxygen, struggling at first to recognise him as her own. "I couldn't even accept him as mine because he was covered in so many pipes," she says. She also could not breastfeed at first, and worried about the cost of his constant oxygen needs.

"I had to let the doctors have faith. But the baby needed constant oxygen, and it was expensive. I was so worried about how we would manage," Jacinter says.

Relief came through medical coverage. "I registered for SHA, and it came through for me. The nurses reassured me that as long as I had SHA coverage, I didn't need to worry about the mounting hospital bills," she says.

Jacinter spent three months in hospital before her baby was strong enough to go home. A month later, he is thriving.

"I am so grateful. I took my baby home, and I am very happy," she says.

Data from the Kenya National Bureau of Statistics, through the 2022 Kenya Demographic and Health Survey, show Siaya recorded 63 deaths among children under five for every 1,000 live births, against a national rate of 41. In 2021, the county recorded 175 neonatal deaths out of 27,783 live births, an improvement on 2020's 250 deaths out of 27,741 births.

Doreen Agina, a clinical officer in Paediatrics and Child Health at the hospital, says the newborn unit receives between 15 and 20 premature babies in some months, from mothers at opposite ends of the age spectrum.

"Some of the youngest mothers seen in the unit are adolescents aged between 14 and 17. For these mothers, premature birth can compound an already difficult pregnancy journey," she says.

Globally, adolescents aged 15-19 face a much higher maternal mortality rate than women aged 20-24, along with greater risk of complications and of low-birth-weight or preterm delivery. The WHO notes that babies born before 37 weeks face significantly higher chances of neonatal death, and are more susceptible to respiratory distress, infections and underdeveloped organs.

Agina says premature birth has multiple possible causes. "These can broadly be divided into maternal, fetal and placental causes. Among maternal causes are infections, anaemia, heart disease and diabetes," she says.

"Placental problems, including placental insufficiency or trauma to the placenta, can also contribute. But in some cases, clinicians do not identify a clear cause. This was the case with Emily," she adds. "When we tried to take the history well, it was just a spontaneous labor that came about."

First-time mothers face particular challenges, Agina says: "They don't know how to go through the pregnancy journey, and this needs to be addressed."

For a premature baby, breathing can become an immediate fight for survival. "A substance known as surfactant, which helps the lungs remain open and function effectively, develops during pregnancy. Babies born very prematurely may not have enough of it. This is why some premature babies require respiratory support," Agina explains.

At Siaya, clinicians use oxygen, Continuous Positive Airway Pressure (CPAP), and caffeine citrate for babies with breathing difficulties. Agina says CPAP has helped reduce mortality by letting clinicians act quickly. "CPAP helps initiate breathing very fast," she explains.

Prematurity is not only about breathing. Babies can also face brain bleeding, feeding and digestive problems such as necrotising enterocolitis, jaundice, infections, periods when breathing temporarily stops, and anaemia of prematurity, each adding another layer to an already fragile fight.

For parents, one of the hardest sights is a tiny baby surrounded by tubes and machines. But those machines can be temporary.

"A baby may initially require oxygen and feeding through a nasogastric tube because the sucking and swallowing reflexes are not sufficiently developed. As the baby stabilises and grows, clinicians can begin moving towards cup feeding and eventually breastfeeding," Agina says.

"The child was eventually discharged after reaching the required weight and becoming clinically stable."

Weight is not the only consideration for Kangaroo Mother Care, though. A stable baby, free from infection, breathing well and with stable vital signs can be considered, provided the mother is willing and counselled. It involves skin-to-skin contact, simple compared with the machines in a newborn unit, but powerful for premature babies, helping regulate body temperature and, according to a UNICEF study, improving neurodevelopmental outcomes.

"It helps us in that the stay of the mother and the baby in the hospital is reduced," Agina says. The warmth of the mother's body also helps prevent hypothermia and supports bonding and breast milk production, restoring, for mothers who have just watched their babies struggle for life, the feeling that they are actively caring for their own child.

Nationally, an estimated 193,000 babies are born prematurely each year in Kenya, about 12 per cent of all live births, and around 13,300 children under five die annually from related complications. The WHO recommends early, regular antenatal care, with at least eight contacts during pregnancy, alongside maternal nutrition support.

Silvester Ng'anda Ochieng, the hospital's Nursing Service Manager, says  newborn deaths have fallen over time. "Previously, the hospital could lose 10, 15 or even 20 babies in a month. Currently, the figure can be around five deaths a month on average, although some months have recorded fewer deaths, including months when no baby was lost," he says.

The hospital has invested in training staff to manage babies at risk. "The newborn unit staff are retained in the unit after gaining competency rather than being routinely moved to other departments," he says, adding that this continuity has improved care for vulnerable newborns. It has also worked with partners to understand why newborns die, using post-mortem feedback to inform management and policy, and has added equipment including radiant warmers, resuscitators, incubators and blankets. But more is still needed. Ochieng says the progress is encouraging, but the work is far from finished.