In Kenya’s crowded public hospitals, fragile newborns are fighting for survival in spaces never designed with them—or their parents—in mind.
A groundbreaking study by KEMRI-Wellcome Trust, the Kenya Paediatric Research Consortium (Keprecon), and the University of Oxford warns that without a redesign of neonatal units to support both caregivers and families, thousands of infants could remain at risk.
A collaborative study titled ‘Harnessing Innovation in Global Health for Quality Care (HIGH-Q) project,’ reveals that inadequate consideration of layout and organization of newborn unit space can hinder care delivery and the implementation of key interventions such as Kangaroo Mother Care (KMC), supportive care for exclusive breastfeeding, and respectful communication.
The observatory study used ethnographic methods with over 250 hours of observation, and 32 in-depth nurse interviews exposed the critical problem.
The study found out that staff shortages, poor newborn unit design, and insufficient family spaces silently undermine life-saving care.
The study, led by a team of researchers including Caroline Waithira, Nancy Odinga, Gloria Ngaiza, and others, highlights that thoughtful neonatal unit designs could dramatically improve care by providing privacy, rest areas, and spaces for parents to bond with their babies. However, the research found a wide variation in layouts, and most designs fail both caregivers and families.
According to the study nursing stations are meant to be communication hubs, but their current placement often creates chaos rather than streamlines information.
The study also reveals that Family-Centered Spaces for Kangaroo Mother Care (KMC), where mothers hold preterm babies’ skin-to-skin to regulate temperature and boost survival, were either inadequate or missing entirely.
Similarly, dedicated breastmilk-expressing rooms, while available in some units, are often overcrowded, robbing mothers of privacy and comfort.
As Dr. Supa Tunje, President of the Kenya Paediatrics Association, explains, “If mothers don’t have a place to rest, to express milk, or to stay close to their infants, we are failing both the family and the child.”
According to Dr Tunje, poorly designed spaces create unsafe environments where infections spread easily.
She explains that explains that NBUs must protect infants from temperature extremes, natural light, and clear spaces for hygiene checks.
Dr Maina says that even the best-designed unit can’t function without adequate staff.
He cites the HIGH-Q data which revealed that Kenya’s neonatal wards are chronically understaffed, with ratios as high as one nurse for every 19 to 25 infants per shift.
“This shortage forces nurses to prioritize only the most urgent cases, leaving crucial tasks like developmental positioning, communication with parents, or breastfeeding support delayed or missed,” he explained.
The physical constraints of these wards only make the problem worse. “Limited space means parents and nurses compete for room, disrupting workflow and eroding family-centered care,” Dr. Maina noted.
The study’s findings point to standardization and redesign of Kenya’s NBUs to support both medical teams and families as active participants in newborns recovery.
Professor Fredrick Were of KEPRECON emphasizes that newborn units are not simply rooms with machines but should be part of the equipment of care.
He said that strategic location of Special Newborn Care Units (SNCUs) should be close to labor, delivery, and postnatal wards to ensure high-risk infants are transferred quickly.
He also called for dedicated family Spaces which should include private, designated areas for KMC and breastmilk expression that allow for peer bonding and supervised support.
Dr Maina emphasized on improved Infrastructure which can adjoin mothers’ dormitories with exclusive access to hygiene facilities and KMC rooms which are essential for sustaining high standards of personal care.
He said that better nurse stations and circulation layouts can streamline workflows and protect confidential communication.
The study reveals that good ventilation, natural light, and temperature regulation are crucial to reducing the risk of infections and respiratory stress.
Despite global progress in reducing child mortality, neonatal deaths remain stubbornly high in sub-Saharan Africa. In Kenya, nearly 40 percent of all under-five deaths occur within the first 28 days of life.
This study reveals that many of the neonatal deaths can be preventable, not just with advanced machines, but with well-trained nurses and better-designed spaces that meet the basic human needs of caregivers and families.
The findings offer a blueprint for designing newborn unit environments where nurses can provide timely care, parents can bond with their infants, and ultimately, more newborns can survive.
