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Taking care of a premature baby at home

DR BOIMA

HEALTH ISSUES


Last week the world celebrated World Prematurity Day on the 17th of November. This is a day commemorated internationally on an annual basis to raise awareness about the issues associated with prematurity or preterm birth. It also spreads information about how to help and support the affected families. At least 10% of families are affected around the world from the 15 million babies who are born prematurely every year. This is especially higher in our continent, the Sub-Saharan Africa and some parts of South Asia.

Prematurity is associated with very high morbidity and mortality, as discussed last week, being the leading cause of death in children under 5 years globally as per World Health Organization (WHO) reports. So diligent care, and high quality measures are needed in taking care of these small human beings. Medical technology has made it possible for premature babies to survive the first few days, weeks or months of life until they are strong enough to make it on their own.

 

When the time comes for these babies to be discharged home most parents relish the return to the privacy and comfort of their homes but many would often get scared and nervous not knowing how to handle these babies or what the future holds for them.

‘Kangaroo care’ –Kangaroo Care also known as Skin-to-Skin Care refers to the method of holding a premature baby in an upright position on its mother’s bare chest for a period of time.  Clothing or blankets are wrapped around the infant to provide a secure kangaroo-like pouch. Usually parents are taught a proper technique of skin-to-skin care and as soon as the baby does not need full-time machinery support the care can be commenced.

Intermittent kangaroo care is widely recognized as a beneficial component of holistic care provision for sick or preterm infants. The benefits for the infant include increased physiological stability, longer periods of quiet sleep, improved heat-regulation development, increased breast feeding incidence and duration, decreased pain perception and reduced stress and crying.  

Parental benefits include enhanced parent-infant attachment with a reduction in the negative effects of having a sick or preterm infant, greater parental ability to recognize their infant’s cues, increased self-confidence, decreased parental depression and increased maternal breast milk supply.

Keep the baby warm –  As mentioned last week preemies are more prone to hypothermia (low body temperature); because of the little fat stores and inability to shiver they cannot generate and maintain their own body heat. So make sure your baby is kept warm at all times and avoid leaving the baby undressed for prolonged periods of time. The best way to keep them warm is making sure you dress them up in layers; for example, a vest, and jumpsuit and wrapped with blanket and a hat and socks. Avoid frequent or prolonged outdoor exposure.

Feeding – Breast milk remains the best in a baby of any age. The mother may have been used to expressing her milk or making a formula feed while in the hospital when the baby was unable to breastfeed due to underdeveloped suckling reflex. An intravenous line or nasogastric tube would have been used to feed some babies. By the time a premature is ready to be discharged they would no longer be in need of tube feeding. The hospital staff would have taught the mother the proper way of breastfeeding and made sure they are doing it competently and confidently before they discharge the baby.

 

They will also have showed her how to encourage the baby to suck, gradually moving him/her towards the breast or formula bottle. Remember that preemies are more prone to hypoglycaemia (low blood sugar) than term babies, which can cause convulsions and produce long-term brain damage. So the wholemark of feeding is to make sure these babies are fed regularly (every 3 hours) and to practice good hygiene habits while at it (washing hands with soap, washing and sterilizing bottles, access to clean/boiled water etc.) to prevent infections. Special ready-made formula milk which is sterile may be recommended in some instances. Weight gain is paramount in the progress of premature babies!

Preventing infections – Premature babies are at particular risk of infection, because their immune system is still developing. It is worth taking care to maintain high standards of hygiene during the early months and years. Parents are encouraged to wash their hands with clean water and soap after changing nappies, when preparing food, after using the toilet and when they have a cold. Visitors should also wash their hands when they enter the baby’s room, and the number of people who hold the baby in the early months should be restricted as much as possible. Pets should also be kept away from the growing baby.

Bathing – How often you wash your baby will depend on how premature s/he is and the condition of his or her skin. For most babies; whether premature or term plain water is fine for the first few months of life. This includes at nappy changing – where only water and soft cotton wool can be used. A premature baby does not need to be given a bath every day. To ensure the baby maintains body warmth make sure you dry them quickly after a bath and immediately wrap them up with a blanket. Sophisticated soaps, shampoos and moisturizers can cause more harm than good, so they are unnecessary!

Helping your baby sleep – You can help your baby develop good 'sleep hygiene' by doing things such as providing a quiet, dimly lit environment at night time. In the early months, however, there's only so much that you can do, because babies get hungry. Also, the smaller the baby, the more often they need to feed. The most important thing about putting babies to sleep is for parents to ensure that infants are slept in a safe environment according to the SIDS recommendations.

SIDS stands for Sudden infant death syndrome which is a syndrome in which apparently healthy babies die in their sleep, usually during the first six months of life. Premature babies are at higher risk for SIDS than term babies. It is still not known exactly what causes SIDS, but we do know a number of things that help reduce it. So before the mother gets discharged healthcare workers educate them on the precautions and tips for reducing cot death.

Dealing with colic – Crying is normal physiological behavior in young infants. Excessive crying is often referred to as "colic". There could be all sorts of reasons why the baby could be crying continuously; s/he could be hungry, very tired, wanting the mother’s attention, or feeling discomfort from wind (known as colic). If the crying happens around the time of feeds, it could be colic or wind or it could be a change of temperature, an unfamiliar smell, or a range of other causes.

If you are concerned that your baby may be unwell, go see the doctor, especially if there are any other symptoms that you are worried about. Preemies are prone to infections and other complications so there might be something wrong worth checking. Using any colic mixtures (both drinking and bathing) like gripe water in infants of any age is discouraged!

Dealing with disability – Premature birth can affect the way your child develops. Early intervention is important, so assessments from your healthcare team are crucial in ensuring that your baby gets the right care. Support from a range of therapies like physiotherapy, occupational therapy and speech therapy, medications and sometimes surgery are usually needed and the earlier they are started the better. Extra support at school might also be needed later on in life. Parents of preemies need to be fully equipped with the information of the therapists is their community.

On a brighter note, premature babies can have a smooth sail in their health and development and catch up with their mates without experiencing any difficulties. For comments and questions please email agboima@yahoo.com

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The past week or two has been a mixed grill of briefs in so far as the national employment picture is concerned. BDC just injected a further P64 million in Kromberg & Schubert, the automotive cable manufacturer and exporter, to help keep it afloat in the face of the COVID-19-engendered global economic apocalypse. The financial lifeline, which follows an earlier P36 million way back in 2017, hopefully guarantees the jobs of 2500, maybe for another year or two.

It was also reported that a bulb manufacturing company, which is two years old and is youth-led, is making waves in Selibe Phikwe. Called Bulb Word, it is the only bulb manufacturing operation in Botswana and employs 60 people. The figure is not insignificant in a town that had 5000 jobs offloaded in one fell swoop when BCL closed shop in 2016 under seemingly contrived circumstances, so that as I write, two or three buyers have submitted bids to acquire and exhume it from its stage-managed grave.

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The Era of “The Diplomat”

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Youngest Maccabees scion Jonathan takes over after Judas and leads for 18 years

Going hand-in-glove with the politics at play in Judea in the countdown to the AD era, General Atiku, was the contention for the priesthood. You will be aware, General, that politics and religion among the Jews interlocked. If there wasn’t a formal and sovereign Jewish King, there of necessity had to be a High Priest at any given point in time.

Initially, every High Priest was from the tribe of Levi as per the stipulation of the Torah. At some stage, however, colonisers of Judah imposed their own hand-picked High Priests who were not ethnic Levites. One such High Priest was Menelaus of the tribe of Benjamin.

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Land Board appointments of party activists is political corruption

30th November 2020

Parliament has rejected a motion by Leader of Opposition (LOO) calling for the reversing of the recent appointments of ruling party activists to various Land Boards across the country. The motion also called for the appointment of young and qualified Batswana with tertiary education qualifications.

The ruling party could not allow that motion to be adopted for many reasons discussed below. Why did the LOO table this motion? Why was it negated? Why are Land Boards so important that a ruling party felt compelled to deploy its functionaries to the leadership and membership positions?

Prior to the motion, there was a LOO parliamentary question on these appointments. The Speaker threw a spanner in the works by ruling that availing a list of applicants to determine who qualified and who didn’t would violate the rights of those citizens. This has completely obliterated oversight attempts by Parliament on the matter.

How can parliament ascertain the veracity of the claim without the names of applicants? The opposition seeks to challenge this decision in court.  It would also be difficult in the future for Ministers and government officials to obey instructions by investigative Parliamentary Committees to summon evidence which include list of persons. It would be a bad precedent if the decision is not reviewed and set aside by the Business Advisory Committee or a Court of law.

Prior to independence, Dikgosi allocated land for residential and agricultural purposes. At independence, land tenures in Botswana became freehold, state land and tribal land. Before 1968, tribal land, which is land belonging to different tribes, dating back to pre-independence, was allocated and administered by Dikgosi under Customary Law. Dikgosi are currently merely ‘land overseers’, a responsibility that can be delegated. Land overseers assist the Land Boards by confirming the vacancy or availability for occupation of land applied for.

Post-independence, the country was managed through modern law and customary law, a system developed during colonialism. Land was allocated for agricultural purposes such as ploughing and grazing and most importantly for residential use. Over time some land was allocated for commercial purpose. In terms of the law, sinking of boreholes and development of wells was permitted and farmers had some rights over such developed water resources.

Land Boards were established under Section 3 of the Tribal Land Act of 1968 with the intention to improve tribal land administration. Whilst the law was enacted in 1968, Land Boards started operating around 1970 under the Ministry of Local Government and Lands which was renamed Ministry of Lands and Housing (MLH) in 1999. These statutory bodies were a mechanism to also prune the powers of Dikgosi over tribal land. Currently, land issues fall under the Ministry of Land Management, Water and Sanitation Services.

There are 12 Main Land Boards, namely Ngwato, Kgatleng, Tlokweng, Tati, Chobe, Tawana, Malete, Rolong, Ghanzi, Kgalagadi, Kweneng and Ngwaketse Land Boards.  The Tribal Land Act of 1968 as amended in 1994 provides that the Land Boards have the powers to rescind the grant of any rights to use any land, impose restrictions on land usage and facilitate any transfer or change of use of land.

Some land administration powers have been decentralized to sub land boards. The devolved powers include inter alia common law and customary law water rights and land applications, mining, evictions and dispute resolution. However, decisions can be appealed to the land board or to the Minister who is at the apex.

So, land boards are very powerful entities in the country’s local government system. Membership to these institutions is important not only because of monetary benefits of allowances but also the power of these bodies. in terms of the law, candidates for appointment to Land Boards or Subs should be residents of the tribal areas where appointments are sought, be holders of at least Junior Certificate and not actively involved in politics.  The LOO contended that ruling party activists have been appointed in the recent appointments.

He argued that worse, some had no minimum qualifications required by the law and that some are not inhabitants of the tribal or sub tribal areas where they have been appointed. It was also pointed that some people appointed are septuagenarians and that younger qualified Batswana with degrees have been rejected.

Other arguments raised by the opposition in general were that the development was not unusual. That the ruling party is used to politically motivated appointments in parastatals, civil service, diplomatic missions, specially elected councilors and Members of Parliament (MPs), Bogosi and Land Boards. Usually these positions are distributed as patronage to activists in return for their support and loyalty to the political leadership and the party.

The ruling party contended that when the Minister or the Ministry intervened and ultimately appointed the Land Boards Chairpersons, Deputies and members , he didn’t have information, as this was not information required in the application, on who was politically active and for that reason he could not have known who to not appoint on that basis. They also argued that opposition activists have been appointed to positions in the government.

The counter argument was that there was a reason for the legal requirement of exclusion of political activists and that the government ought to have mechanisms to detect those. The whole argument of “‘we didn’t know who was politically active” was frivolous. The fact is that ruling party activists have been appointed. The opposition also argued that erstwhile activists from their ranks have been recruited through positions and that a few who are serving in public offices have either been bought or hold insignificant positions which they qualified for anyway.

Whilst people should not be excluded from public positions because of their political activism, the ruling party cannot hide the fact that they have used public positions to reward activists. Exclusion of political activists may be a violation of fundamental human or constitutional rights. But, the packing of Land Boards with the ruling party activists is clear political corruption. It seeks to sow divisions in communities and administer land in a politically biased manner.

It should be expected that the ruling party officials applying for land or change of land usage etcetera will be greatly assisted. Since land is wealth, the ruling party seeks to secure resources for its members and leaders. The appointments served to reward 2019 election primary and general elections losers and other activists who have shown loyalty to the leadership and the party.

Running a country like this has divided it in a way that may be difficult to undo. The next government may decide to reset the whole system by replacing many of government agencies leadership and management in a way that is political. In fact, it would be compelled to do so to cleanse the system.

The opposition is also pondering on approaching the courts for review of the decision to appoint party functionaries and the general violation of clearly stated terms of reference. If this can be established with evidence, the courts can set aside the decision on the basis that unqualified people have been appointed.

The political activism aspect may also not be difficult to prove as some of these people are known activists who are in party structures, at least at the time of appointment, and some were recently candidates. There is a needed for civil society organizations such as trade unions and political parties to fight some of these decisions through peaceful protests and courts.

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