The streets of Harper City, Maryland County, come alive with joy and celebration in January every year. Strolling through, you’ll encounter smiling mothers proudly parading with their children securely wrapped in lappas [African cloth] on their backs. You wouldn’t imagine that these same mothers and relatives once lived in the shadow of fear, dreading the possibility of losing their own lives or those of their babies.
On January 10, 2025, families gather to celebrate the graduation of their preterm children from Partners In Health (PIH) Liberia’s and Maryland County Health Team’s Kangaroo Mother Care (KMC) Program in 2024. The KMC is a well-known approach that clinicians around the world use to decrease the deaths of premature newborns, especially in countries like Liberia, where incubators and reliable electricity are hard to come by.
A total of 63 children were certified and graduated from the KMC program. Among the proud caregivers were Elizabeth Appleton, the elder sister and guardian of 9-month-old Dorothy Nysua, who tragically lost her mother after childbirth, and Sarah Howe, a 42-year-old mother of twin babies – a boy and a girl.
Elizabeth explained that when her mother was sick during pregnancy, her 11th pregnancy at the time, she took her to the Cavalla Rubber Corporation Health Center, where they were referred to James Jenkins Dossen (JJD) Memorial Hospital in Harper. At JJD, she underwent a successful cesarean section but died 8 days later due to eclampsia and malaria during her 31st week of gestation.
Elizabeth Appleton, a caregiver for Dorothy Nysua of the Kangaroo Mother Care (KMC), receives certificate of appreciation from Johnet V. T. Clarke, neonatal specialist at J.J. Dossen Hsopital in Harper, Liberia, upon completion of the 2024 KMC program cycle. Photo by Ansumana Sesay / PIH
As Elizabeth received the certificate, Dorothy’s curious, shining eyes, behind the certificate in her sister’s arms, could not go unnoticed as she attempted to hold the certificate too. Barely six months ago, Dorothy was admitted to the neonatal intensive care unit, NICU, at JJD for three months because she was born as a preterm with a low birth weight of 1.75 KG. Born to a single mother from a home with an absent father and no relatives to care for her, her elder sister, Elizabeth, volunteered to care for her younger sister upon the passing of their mother.
The crowd applauded Elizabeth and Dorothy as they received the KMC program’s completion certificate. These applauds were not only for the euphoria of the moment but also for the hope of a future full of possibilities for Dorothy and the many other children, which has been kept alive by providing preferential health care options for the impoverished. In Maryland County, 9 people out of 10 are impoverished.
A popular family planning slogan in Liberia says, ‘baby by choice, not by chance.’ Sarah was a mother of five children, all girls, and she said she and her children’s father wanted a boy, a baby by choice. But there was a challenge when her twins were born. They were born premature and with low birth weights of 2.4 and 1.5 kgs and infected with sepsis after undergoing cesarean section. Sepsis is one of the three major causes of neonatal deaths in Liberia.
Danger of Preterm Survivability in Liberia
Worldwide, an estimated 13.4 million babies were born preterm in 2020, with preterm birth complications remaining the leading cause of death in children under 5 years globally. A premature baby’s chance of survival is heavily influenced by where they are born, with those in low-income countries facing significantly higher mortality rates than those in high-income settings. Alarmingly, in Liberia, 22,000 babies are born prematurely each year, and 1,210 children under five die due to direct preterm complications.
Liberia’s under-five mortality rate is 93 deaths per 1,000 live births, and the infant mortality rate is 63 deaths per 1,000 live births. Demographically, these mortality rates are incredibly high among women who are not literate, have no formal education, or are widowed, divorced, or hail from poorer households. Maryland County is one of the poorest counties in Liberia.
Increased Chance of Preterm Child Survival Through KMC in Liberia
After a decade of consistent investments by PIH, in partnership with the Maryland County Health Team (CHT), in maternal and child health services, the survival rate for preterm and low birth weight babies and hope for their mothers have begun to increase since the inception of the KMC Program in 2018. Like all the mothers who carried their babies on January 10, 2025, Elizabeth’s little sister, Dorothy Nysua, and Sarah’s fraternal twins survived mainly because they were enrolled in the KMC program.
Before the graduation, Elizabeth conveyed gratitude for the social support she and her sister received during the KMC program.
“I don’t have money,” she said. “None of my ma [mothers] family members came around to say our daughter left a child back (behind). PIH people are strong. [Dorothy’s] clothes, milk, medicine, and everything were on time,” Elizabeth reflected.
The KMC is a well-known method that clinicians worldwide use to decrease the deaths of premature newborns, especially in countries like Liberia, where incubators and reliable electricity are hard to come by. The method involves infants being carried, usually by the mother, with skin-to-skin contact. The direct contact promotes temperature regulation, early breastfeeding, and mother-infant bonding.
Sarah Howe, a twin mother of the Kangaroo Mother Care (KMC), receives certificate of appreciation from Charles Jarsor, nursing director at J.J. Dossen Hsopital in Harper, Liberia, upon completion of the 2024 KMC program cycle. Photo by Ansumana Sesay / PIH
Similarly, Sarah expressed how relieved she is to have her babies alive.
“I [am] happy because maybe if they [doctors and nurses] were not going to operate on me and take care of my children, maybe I was going to die or my children [were going to die],” Sarah expressed after the graduation.
Since the onset of the KMC program in Maryland County in 2018, PIH Liberia and the Maryland County Health Team have made massive progress toward reducing neonatal mortality. The initiative has followed 874 KMC babies, enrolled 424, and graduated 258.
In close partnership with the government, PIH continues transforming Maryland, an area with the lowest number of health care providers in the country, into a vibrant health system with top-notch care for the region and neighboring Ivory Coast.
