Fighting newborn deaths should focus beyond facility deliveries
For over a decade now, a number of key efforts have been made in Uganda in an attempt to reduce the number of newborn deaths from 27/1000 live birth in 2011 Â to 23 per 1,000 live birth in 2015. The 2030 global target for the Sustainable Development Goals stands at 12/1000 lives births.
The latest available data on the total deliveries conducted in health facilities show some great improvement over the last two financial years. According to the Health ministry, in the 2013/2014 financial year, there were 3,074,671 deliveries conducted compared to 3,103,926 of 2014/2015 indicating an increase of 1 percent. Though there is great improvement in the number of facility based deliveries conducted, there is stagnation in the number of facility based newborn deaths at 23/1000 live births. This is far below when compared to Health Sector Strategic Improvement Plan (HSSIP) target of less than 23/1000 live births.
Looking at Iganga District, one of those with the highest fertility in the country, the total number of deliveries conducted in the financial year 2014/2015 were 29,738 and total newborn death were 189 in the same financial year, as per data from the Health Management Information System(DHIS2(e-HMIS), 2016). Evidence has it that increasing access and utilization of facility-based maternal care alone does not necessarily translate into better newborn outcomes. In this context, probably poor quality of care of newborn care at birth in many facilities may be the plausible explanation for this reality. Quality is the actual extent at which newborn health care services are delivered according to the standard of care. Delivery of care services in a timely, effective way while ensuring safety of newborns decreases the likelihood of birth asphyxia, sepsis, and malformation, among other complications. In a study published by Namazzi and others in 2015, it was reported that poor-quality health facility care was the second leading reason for newborn deaths in rural eastern Uganda. Similar findings were reported by Waiswa and others in the paper titled â€œUsing the three delays model to understanding why newborn babies die in eastern Uganda.â€
Preliminary findings of my research conducted between June 5 and August 30, 2016 in seven health facilities including a hospital, three Health Centre IV and three Health Centre III facilities, to determine the quality of newborn care in Iganga District, reveal that facilities have the required equipment and health work force. However, there was reluctance on following the recommended standards of newborn care. For example only 44% of newborns got initiated to breath within the first 30 minutes of their life on earth. Yet some babies die due to difficulties in breathing from blocked air path ways. Â Lack of training among some health workers which limited their knowledge on newborn care and there was no plan for the in house training in the visited facilities. The non-adherence to standard newborn care practices may have not been appreciated due to lack of training on newborn care among health workers. The implementing partners trained few health workers on helping newborns breath in the selected facilities.
Regarding the availability of essential medicines and supplies, it was good (86%). Â Essential medicine and supplies such as tetracycline eye ointment, intramuscular vitamin K, BCG and OPV were available at the service points. This was because of implementing partners who provided finances to some facilities for the procurement of medicines and supplies which reduced stock out levels.Â However, this was an improvement from 40% stock outs that was reported by (Namazzi et al., 2015) to 86% of this study. Availability of medicine and supply was 80% in the general hospital, 100% in HCIV and 80% in the HCIII.
To this, I believe that as we push for health facility deliveries, attitudes of health providers also need to change to facilitate good quality of care, if we are to reach the dream of reducing newborn deaths to 12/1000 live births by 2030.
*Written by Mr Ronald Nyakol, a Masters of Health Services Research student at MakSPH and one of our 2016 research grant awardees.