While Iganga District in Busoga Sub-region of Eastern Uganda is synonymous with twin births, a mother giving birth to five babies at once on the night of August 23 and the morning of August 24 2019 was big news and it attracted hordes of people to Iganga Hospital wanting to have a glimpse of 30 year old Safiyati Mutesi (Below standing with health workers).
A mother giving birth to five babies at once was also a first in the 51-year history of Iganga General Hospital and health workers attached to different units at the facility were also among the curious crowds on the morning of August 24.
Members of the public continued checking in to have a glimpse of Safiyati and her quintuplets through their 28-day hospital stay, which we also witnessed on September 20, the day the family left hospital for home, some 40 kilometres away in neighbouring Namutumba District.
“It has been like this right from the day I delivered and many times we have had to lock the door in order to get some rest but also protect the babies from possible infections from those people,” said Safiyati as she fed one of the babies.
The Nursing Officer in charge in charge of the Special Care Unit at Iganga Sr Maureen Babine said given the peculiarity of this delivery, they could not completely bar visitors but restricted entry to one person at a time to the private room in which the family was booked with financial help from the Namutumba Woman Member of Parliament Mariam Naigaga. “We told them these were high risk babies and did not need visitors because they could make them sick. We could not chase them since some wanted to offer some financial help to the family.”
With prior history of giving birth to twins and triplets, Safiyati did not have any complications during her pregnancy. However, trouble only arose during delivery when her first baby came out at the entrance of a health facility near her home and the postnatal bleeding at the end of her 5-baby delivery process, 40 kilometres away, in Iganga.
Skilled attendance
Although it is apparent that Safiyati delayed home, she was lucky to be in a catchment area where different studies under the auspices of the Makerere University Centre of Excellence for Maternal and Newborn Health (MNCH Centre) have created a regional network of maternal and newborn care that has linked several health centre IVs and hospitals through refresher trainings on emergency obstetric care, quality improvement collaboratives and ongoing mentorship among other things.
“We are glad that colleagues at these lower health facilities whose capacity we have built over time were able to effect timely referral. We have been emphasizing early identification of complications and timely referral,” says MNCH Centre Lead Prof Peter Waiswa. “It is not usual that five small babies are born, and all survive through the newborn period even in the best of settings. We are glad that the specialised newborn care capacity we have been building over time at Iganga did not go to waste.”
Studies show that multiple pregnancies often come with an increased risk of death for women and children because of higher rates of obstetrical complications and quality of care issues in resource limited settings. To mitigate bad neonatal outcomes, institutional deliveries with possible caesarean sections are highly recommended.
When Safiyati arrived at Iganga with an accompanying nurse from Nsinze Health Centre IV, they found Midwife Mary Lugolole (Centre) on duty, a beneficiary of the MNCH Centre capacity building programmes.
“When I got transferred to Iganga Hospital from a Health Centre III, everything looked new to me and I did not know how to handle obstetric emergencies. I am not sure if I would have managed the Safiyati case if it had come at that time,” Midwife Lugolole recalls. “However, after a week at the new station my superiors seconded me to PRONTO training under the Preterm Birth Initiative project where I learnt the skills I am applying, complemented by ongoing on-site mentorship from my superiors who also benefitted from the same training.”
Infant and Under 5 mortality hurdles
A 2008 Nigerian study found that children born multiple births are more likely to die during the first year of life compare to children born singletons, independent of child’s sex, birth order, pregnancy care and delivery care, maternal education and nutritional status, household access to clean water and sanitation, and other factors. Similarly, a 2017 publication in The Lancet based on data pooled from 90 Demographic and Health Surveys for 30 sub-Saharan Africa countries including Uganda on births reported between 1995 and 2014 found that twins account for 10·7% of all under-5 deaths and 15·1% of neonatal deaths in the region and these percentages are increasing. The study estimated the total number of annual twin deaths to be 315000 in the surveyed countries.
Safiyati’s multiple babies are not any different from the cases referred to in the above studies. While in hospital for over three weeks, medics could easily check these low birth weight babies and act if need arose. However, they are now back in the community, a totally different setting from the hospital. Continuing with Kangaroo care, maintaining hygiene and warmth, as well as infection control and proper feeding will be critical in the care of the quintuplets for better outcomes.
A technical shot in the arm
At discharge the MNCH Centre arranged and had two staff members from the Iganga Hospital Special Care Unit escort the family home and help set up the babies’ place of aboard. They also gave a health education talk on newborn care to the gathered community.
Also, with support from the MNCH Centre, a neonatal nurse from Iganga Hospital will make a monthly visit to the family to assess the health status of the babies. According MNCH Centre’s Prof Waiswa, this will be initially done for three months. “Follow up is critical for such high-risk babies. With the support they have been getting while in hospital reduced, following them up in the community will be important.”
The mother and her babies with her husband a helping family member are currently staying in a two roomed house less than a kilometre from their mud and wattle grass thatched hut where the older children are staying.