Ugandan district hospital embraces maternal and perinatal death surveillance and response
By Susie Gurzenda |
Uganda has had a maternal death review for over a decade, however it had not been an effective mechanism for identifying and addressing gaps in care that lead to deaths. According to health care professionals I spoke with, at the worst the maternal dearth review was used just in the maternity ward to identify and accuse scapegoats, and at best it was used to identify gaps in care, but without taking action.
When implemented correctly, maternal death review boards have had great success in reducing maternal deaths in other context, and could help Uganda meet its targets for reduced maternal and perinatal death. Maternal and Perinatal Death Surveillance and Response (MPDSR) emphasize the “response” component of the program. MPDSRs make sense when implemented at the national, regional, and district level as well at all levels of health facilities down to the community level.
For the Iganga District Hospital, Dr. Rolland Mutumba (Paediatrician), Senior Midwife Agnes Batani and Dr. Jude Mulowooza (OBGYN) are leading the implementation. The team gave an informational lecture to the hospital staff this week about the implementation of MPDSR at the hospital over the next month and collected volunteers to form the advising committee. The program is to be implemented across all wards of the hospitals to catch all maternal and perinatal deaths, not just those that take place in the maternity ward. The staff embraced the tool as a mechanism to improve care at their facility and create response plans to lower maternal and perinatal death.
After the lecture, I had the opportunity shadow Dr. Mutumba and Agnes the senior midwife on the maternity ward as they addressed one of the primary challenges of lowering neonatal mortality in facilities: coaching mothers to improve neonatal care methods.
Agnes and Rolland work together to teach mothers newborn care methods that often involve a significant and challenging behavior change. Kangaroo Mother Care (KMC), for example, is a World Health Organization-recommended method of care for stable, small and preterm newborns, and it proscribes mothers to keep their baby on their chest for up to 18 hours a day. I asked Agnes what methods she has found to teach KMC so that mothers understand the benefits and comply with the time-intensive care method. She replied: “I have many tricks! These young mothers are scared, and they don’t learn anything when they are scared, so you have to make them laugh and have fun with them.”
The more I learn about neonatal mortality in Uganda, the more I struggle to identify a concise determinant of stagnated NMR. There is not one reason for stagnation, but instead a complicated web of determinants across many fields including demography, epidemiology, politics, biology, sociology, finance, and beyond. This is of course the nature of public health: there are always various determinants of health that extend beyond the social and biological. In many ways, the lynch pin to success at Iganga seemed to be heightened quality of care.
It has been most valuable to speak with doctors and nurses about their challenges and successes in reducing neonatal mortality in Uganda. I am optimistic that under the leadership of health professionals like Rolland, Agnes, and Jude, the new iteration of MPDSR will provide opportunities for health facilities to identify bottlenecks and implement changes in care to reduce maternal and perinatal death in their facilities.
*The author is a Master of Science Candidate in Global Health at the Harvard T.H. Chan School of Public Health. She’s currently on a month-long placement at the Makerere University Centre of Excellence for Maternal Newborn and Child Health