Hospital networking, integration of maternal with newborn care boost survival of preterm babies
By Kakaire Ayub Kirunda | AS we commemorated yet another World Prematurity Day on November 17th 620 babies were born prematurely (before 37 completed weeks of gestation) in Uganda by the end of the day. With this happening every single day, up to 226,300 preterm births are registered annually in the country.
Globally, preterm birth complications are the leading cause of death among children under 5 years of age, responsible for about one million deaths, according to the World Health Organisation. In Uganda, available statistics show that preterm birth related complications contribute to one third of babies who die before they make one month. And babies who die before making one month contribute significantly to the under 5 deaths in the country.
To realise the childhood mortality targets of Sustainable Development Goal 3 (which is on improving health and well-being), Uganda will need to by 2030 end preventable deaths of newborns and children under 5 years of age by aiming at reducing newborn mortality to at least as low as 12 per 1,000 live births (currently at 27/1000) and under-5 mortality to at least as low as 25 per 1,000 live births (now at 64/1000).
However, according to the United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) 2017, going by the current trends, while Uganda is likely to meet the under 5 mortality by 2030 unlike in the case of newborn mortality which may only be realised by or after the year 2050.
Given the contribution that preterm birth related complications make towards both newborn and under 5 mortality, now is the time for issues of prematurity to top the healthcare agenda in Uganda.
Ironically, amidst an apparent grim situation, research shows that more than three quarters of premature babies can be saved with feasible, cost-effective care. The WHO lists such care as “essential care during child birth and in the postnatal period for every mother and baby, provision of antenatal steroid injections (given to pregnant women at risk of preterm labour and under set criteria to strengthen the babies’ lungs), kangaroo mother care (the baby is carried by the mother with skin-to-skin contact and frequent breastfeeding) and antibiotics to treat newborn infections.”
In partnership with the University of California San Francisco (UCSF), we [at Makerere University] have since 2016 been testing a four-part package designed to strengthen facility care for mothers and newborns in the intrapartum and immediate postpartum periods in six Eastern Uganda hospitals under a project called the Preterm Birth Initiative (PTBi) from which we have learnt key lessons.
PTBi Component one is on Data Strengthening. We believe good data is an important tool in improving the quality of care. It can demonstrate the need for change and pinpoint gaps and weaknesses in both health care facilities and in care of women and preterms. Relatedly, we have a component on the WHO Safe Childbirth Checklist. We have modified the WHO Safe Childbirth Checklist to focus on five specific time points in labour, delivery and the post-delivery period. The third component is on Birth Simulation & Team Training. This has enabled healthcare providers to practice skills in high-stress situations, developing the muscle memory necessary during an actual emergency. Our fourth component is continuous Quality Improvement (QI) cycles. Through the simulation and team training, opportunities to improve the system are identified and improved.
From PTBi there has emerged a network of six hospitals where teams of Paediatricians, Obstetricians, Midwives, Nurses and Administrators are collaborating at regional level to improve preterm birth outcomes. The second lesson we pick from this initiative is that integrating maternal and newborn care is critical to the survival of preterms. We have also learnt that preterm care needs holistic health system support addressing all the building blocks.
However, as we strive to save as many preterms as possible, many face lifetime learning disabilities, visual and hearing challenges, which calls for more investment into addressing this reality, which is detrimental to their well-being as espoused by SDG 3.
*The writer is the PTBi Uganda communications lead.