Infant mortality; shielding sick newborns way to go

Article posted on The Razor Newspaper, written by Kakaire Kirunda

It is just under five years to the 2015 deadline of achieving the eight Millennium Development Goals (MDGs) set by UN member states following a commitment made at the millennium summit in 2000.

Sadly, we are off track as far as MDG 4 which requires a reduction by two thirds, between 1990 and 2015, the number of deaths among children aged five and below. In Uganda, for every four children who die before five years, one is a neonate, or a death before one month of life. Over 45,000 neonates die annually. These numbers might actually be higher. Most of these deaths are virtually invisible, occurring at home and often going unregistered. Similarly, there is an estimated 40,000 still births that occur yearly.

I am not sure if we can still salvage our situation before 2015, but on a recent visit to Iganga District I learnt from an ongoing study that there are some simple interventions that can make a difference if replicated at all our district hospitals. The Uganda Newborn Study (UNEST), being conducted in sample villages under Makerere University’s Iganga – Mayuge Demographic Surveillance Site in partnership with Sweden’s Karolinska Institutet, has come up with creative innovations aimed at improving newborn survival. Among the most impressive is helping Iganga District Hospital establish a very low cost Sick Newborn Room.

The advantages that come with such a facility are that sick newborns are separated from other children. By doing this, the delicate infants are protected from infections from older children on the general paediatric ward. A nurse on duty -at the time of my visit- said previously, sick newborns would initially be treated on the maternity ward and later on the general paediatric ward. Similarly, treatment was not systematic in addition to not being suitable for neonates. This state of affairs was a recipe for disaster.

However, the establishment of a special room for sick newborns within the paediatric ward has led to many changes which the hospital has since adopted. With funding from the Gates Foundation and Save the Children, UNEST was able to transform a section of the pediatric ward. Health workers were trained on the job in newborn care including resuscitation.

But amidst low health literacy levels and a shortage of skilled health workers, someone in the community needed to help mothers make use of the new unit. UNEST recruited and trained an army of community health workers (CHWs) to visit mothers two times during pregnancy and three times after delivery. The CHWs could pass off for members of the Village Health Teams as per Government policy.

None-the-less, in the context of this article, visiting mothers three times (within 24 hours after delivery, 3rd day, and 7th day) within the first 28 days of a baby’s life is vital in a country where majority of mothers deliver without skilled care. Screening for and counseling on maternal and newborn danger signs with subsequent facilitation of referral; assessing for difficult breathing; counseling mothers on breast feeding, cord care, skin care and birth spacing; and referral for immunization by CHWs are making are boosting newborn survival in this area.

Basing on the Iganga experience, I am now among those who think that as we continue to dream of a time when there will be mega funds for a fabulous health system, simpler approaches at the family-community level and through outreach services can be used in the meantime.

The UNEST approach, if replicated, as soon as yesterday, could move us closer to attaining MDG4. There is a ray of hope already. According to the UNEST lead researcher Dr Peter Waiswa, the intervention will soon move to the rest of Iganga, Mayuge and expanded to Kamuli and Buyende districts.

The author is a journalist attending a fellowship at the Makerere University School of Public Health.
akakaire@gmail.com