Article posted on The New Vision
By Catherine Ruhweza
FIFTY-five-year-old Mukooza is a father of four from Buwaya sub-county, Mayuge district. He is a subsistence farmer and a respected personality in his village.
Two years ago, his village chose him to train as a community health worker, (CHW) with Uganda Newborn Study (UNEST).
UNEST assesses the feasibility of using community health workers to combat maternal and newborn deaths.
The project, being implemented in eastern Uganda, is a partnership between Makerere University School of Public Health, Save the children Uganda and Karolinsika Institute, Sweden, which give technical support.
Although this is voluntary work, Mukooza’s commitment is impressive. “I have never missed any of my scheduled visits to the mothers. I am happy to be making a difference in my community,” he says.
Twenty-year-old Justine, a first-time mother is one of the clients Mukooza must visit this month. She is due to have her first baby in two weeks’ time.
Mukooza will teach Justine about the danger signs in pregnancy, signs of labour and birth preparedness. He will remind Justine about breastfeeding soon after birth, cord care and the need to keep the baby warm.
The study coordinator and principal investigator, Dr.Peter Waiswa, says the study is the first of its kind in Uganda and among the very few done in sub-Saharan Africa.
“Similar studies have been done in low resource settings in Asia with positive outcomes,” he says.
Dr. William Bazeyo, the dean, Makerere University School of Public Health, says the results from the study will be used to inform national policy on the most cost effective ways to save the lives of mothers and newborns.
“We hope through this study we will be able to share experiences and training materials, and provide information on the cost-effectiveness of community health workers, and how to integrate them into maternal and newborn implementation programmes in Uganda.”
In Uganda 45,000 babies die every year within a month of birth. The leading causes of death include infections, breathing problems at birth, premature birth and/or low birth weight. All these can be intercepted at the household level.
Research shows that 75% of neonatal death happens within the first seven days after birth.
Based on this study, a plan to pay particular attention to this period, with community health workers making two visits to the mothers, has been designed.
Mothers and babies with danger signs are immediately referred to the health units where there is quality care, trained personnel, equipment and drugs, and support supervision is available.
Under UNEST, community health workers are continuously supervised and their knowledge on pregnancy and newborn care is continuously assessed, tested and enriched.
Dr. Hanifa Naamala Sengendo of Save the Children Uganda says they are excited about the project. “Newborn death contributes to about 40% of child mortality.
The UNEST study has unique components of community involvement in improving newborn care and that is big component of sustainability,” she says.
Achievements of the project
Health centre community linkage: The study has created a strong relationship between the community and health centres by linking them through supervision and a feedback.
This is done through monthly meetings between the community health workers and the health centre staff. This has removed health centre biases and improved working relationships between the community and health workers at the village level.
Improved relationship with the district: The study improves communication between the health centres and the district health services.
In most cases far off health centres are cut off from close monitoring and supervision. But because of the nature of the study, the district gets feedback from the health workers in the most remote centres.
Increased functionality of health centres: The implementation of the study demands functioning health centres. This has strengthened health units within the area of implementation.
The health centres have been equipped to meet standards that support the implementation of the study and hence serve the community better.
Facility deliveries in the areas of implementation have risen by almost 35%.
Use of partographs: Before the implementation of the project, partographs use was almost non-existent.
A partograph is a labour monitoring tool that tracks the time and progress of labour.
Before the project started, about 90% of the medical workers in the delivery units did not know how to use partographs but now every midwife knows how to use the tool, and this is helping save mothers and newborn babies.
Strengthening of neonatal care at the facilities: Working with leading neonatologist, Dr. Nakakeeto Margaret, neonatal facilities have been set up in the implementation area.
Sections of maternity wards have been turned into neonatal sections. At Iganga Hospital, UNEST has put up a separate neonatal unit to support the region.
Neonatal care knowledge: Before the implementation of the study, the knowledge of care for the newborn was limited.
Most of the health workers had never undertaken training in neonatal care. Now the health workers in all the health units in the implementation area have undergone training. This has improved newborn care tremendously.
Kangaroo mother care: A story is told of a mother who was found in Iganga Hospital with two small premature twins, one weighing 1.5kg, and another1.7kg, wrapped in wet clothes on the fifth day after birth, cold, very weak and being fed on sugar water since birth. She had engorged breasts.
Through the kangaroo mother care intervention and breastfeeding, the babies were saved and now they are two years old.
Kangaroo care was, until then, unheard of in this part of the country. Babies were either kept warm using charcoal stoves or hidden in layers of clothes.
Research shows that kangaroo care can prevent neonatal deaths by 30 to 50%.
Record keeping: Record keeping is a very crucial but most neglected aspect in monitoring maternal and newborn care and morbidity. Before the study, records at health units were poorly kept.
Comprehensive record keeping is key to improving maternal and newborn care.
Health workers have been trained in proper record keeping. This has enabled the units to track all maternal and newborn births, deaths and identify gaps in care.
Improved knowledge in the community: The community has been sensitised of the recommended newborn and maternal care practices.
Knowledge alone can reduce maternal and newborn deaths by 30%. Through community health workers, best practices are passed on to the community.
Community commitment to lve their problems: Although the community health workers are not remunerated, their level of commitment is impressive. So far there has been zero dropout in rural areas, but three dropouts in urban areas.
For motivation they are given a T shirt, a bag, teaching materials and transport refund of sh10,000 for monthly meetings.
The level of commitment shows that maternal and neonatal care can be implemented at the community level.