Globally, neonatal deaths contribute 45% of the 6 million annual deaths in children under-five years of age (Another 2.8 million babies are deemed stillborn but some may be able to be successfully resuscitated).Uganda’s neonatal mortality rate is 27 per 1000 live births and has stagnated in the last 15 years. Preterm birth before 37 weeks gestation, constitutes fourteen percent of the 1.66 million births annually and is approximately twice that in developed countries. Premature babies (many of whom are otherwise well) account for approximately a-third of neonatal deaths (deaths within the first 28 days after birth). Other significant causes of neonatal mortality and morbidity include failure to breathe at birth (perinatal asphyxia) and infection. However, over 90% of deaths of premature babies are preventable using current knowledge and basic clinical care.
This project aims to improve survival of premature babies and potentially act as a model for Uganda and other LMICs to help achieve the UN sustainable development goal 3 target 2 (By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1000 live births and under 5 mortality to at least as low as 25 per 1000 live birth).
Mbarara Regional Referral and Teaching Hospital (MRRTH), located about 260 km to the southwest of the Ugandan capital of Kampala, has an estimated 460 bed capacity and serves about 7 million people. It also serves as the teaching hospital for Mbarara University of Science and Technology. Approximately12, 000 deliveries are conducted at MRRTH per year with an additional 1100 babies transferred from other regional and low level health centres for specialized care. The current newborn unit accommodates over 40 neonates in a space designed for 15 neonates. The unit has improvised smaller neonatal cots while mothers stand next to them waiting on their sick babies.
The rotary club of Mbarara in partnership with Rotary Club of Calgary Stampede Park remodeled the space during the RY 2019/2020 to accommodate 4-5 hospital beds. Annually, this unit admits 2000 newborns; forty percent of these are premature babies, with about 200 newborn deaths occurring, and 70% of whom are pre-term babies.
In the MRRTH neonatal unit, the major causes of death among premature babies include inability to keep warm (hypothermia because they are too small and unprepared to keep themselves warm) and infections. Both conditions are commonly complicated by rampant poor nutrition.
Kangaroo Mother Care (placing and covering the baby skin-to-skin on the mother’s chest) recommended by WHO has been shown in various settings including developing countries to be an effective inexpensive way of keeping babies warm, facilitating weight gain and reducing mortality as well as length of hospital stay of premature babies. Though MRRTH has been implementing parts of KMC, the main challenge has been the lack of equipment to monitor premature babies and a safe and comfortable environment where mothers or caretakers can have their basic personal needs met to practice kangaroo care. As of January 2020, the conditions in the MRRTH newborn units were poor. The unit had 1 thermometer, no bilirnbinometers and other basic medical equipment necessary for clinical care of premature babies.
In addition, at least 2 babies shared a cot. This close proximity of premature babies to each other increases the risk of transmission of infections. There was no designate critical care for these delicate babies therefore in instances where supplemental oxygen or intravenous infusion of fluids are needed, these babies are moved to the general paediatric emergency room, which often has many other critically ill children. Key to note, the paediatric emergency room had limited monitoring equipment for newborn babies. Even with the existing monitoring equipment, the frequent power outages brings significant challenges since the majority of babies in these units dependent on supplemental oxygen provided by machines driven by electricity.
Therefore, this program will be to enhance care of premature babies and create more room for other critically ill children. Our overall goal is to reduce newborn morbidity and mortality and improve survival of premature babies in south-western Uganda by establishing Kangaroo Mother Care (KMC) at Mbarara Regional Referral and Teaching Hospital.
This will be achieved through equipping the newborn care units with basic equipment and supplies for enhanced newborn care at MRRTH, Provision of training for health care personnel providing care to newborns to equip them with the knowledge, skills and attitudes needed to deliver improved newborn care, equipping health care personnel with knowledge and skills to teach mothers (and alternate caregivers such as fathers and grandmothers) the basics of KMC in MRRTH thus facilitating earlier hospital discharge. It is anticipated that mothers given the appropriate education will be able to assist other mothers thus freeing up health care personnel for more direct clinical care and enhancing opportunities for sustainability (experienced mothers teaching less experienced mothers).
Through this global grant , we have been able to supply a stand power backup system, equipment for the neonatal unit that include Oxygen concentrators, Bilubinometers, Phototherapy machines to mention but a few.
