Why there’s no decline in newborn deaths despite gains in child and maternal health, skilled births in Uganda
There must be excitement in the country. The preliminary results of the Uganda Demographic and Health Survey (UDHS) 2016 were released March 14. The results are a mix of good news, some not so good news, and bad news for maternal, newborn and child health in the country. The last five years have seen strides in Uganda. And as expected, the greatest news is linked to older children beyond one month of life. The last five years have witnessed a further reduction in infant deaths (above one month to just before the first birth day) by 20.4% from 54 to 43 per 1000 live births, and under five mortality reduction by 29% (from 90 to 64 per 1000 live births). I take this opportunity to congratulate the parents, communities, health workers, the Ministry of Health and its partners, and the government on these strides on saving what I call “the easier to save kids”. In subsequent write ups, we will discuss “what is the country doing right and where do we need to focus to make further progress.” For now, I invite a debate on this.
Another good but “not so good” news but indeed an opportunity is that the findings show that the number of pregnancies women are getting has reduced by 13 % from a total fertility rate of 6.2 to 5.4 per woman. Most of these women now deliver in health facilities. There has been a 22% increase in “skilled birth attendance” and “health facility delivery” from 58% to 74% and 57% to 73% respectively. In other words, most Ugandans now deliver in a health facility and only about 27% deliver elsewhere (home, Traditional Birth Attendant or on the way to hospital). These improvements show that it is now unfashionable to deliver at home, and that perhaps access to delivery care has improved. The increasing births in facilities should be an opportunity to provide women with both the perceived and technical quality of care they need. This should be easier since the women have already come to us and are within our confines. Providing quality care at birth to women who come to facilities and identifying and supporting those who fail is now the greatest test for the government and those who support it.
The other ‘good” to “not so good” news is that the number of women who die of a maternal deaths seem to be going down. It was reported as reducing from 438 to 368 per 100,000 live births, suggesting a 16% reduction. This is indeed good news, although a closer look at the data shows that the actual figure is between 301-434, which is close to that of 2011, meaning that we cannot cerebrate yet. Indeed, as if to back my assertion, the UDHS 2016 preliminary findings show that neonatal mortality rate for 2011 and 2016 has remained the same, 27 per 1000 live births. This is what I call the “BAD news” and I refer to newborns (and stillbirths who are actually not reported in this preliminary report) as “the forgotten children” of Uganda. The entire system (government, donors or private) has tended to focus on older children and forgotten these ones, yet without equitable access to quality facility based care 24-7 hours we cannot make a difference. For the other kids, “the care can be delayed”, but not newborns and their mums.
As we await final findings and therefore a detailed analysis, my recommendations for now are:
- Bridge the contraceptive gaps;
- Ensure women deliver only from fully functional health facilities and that they have access to emergency obstetric care;
- Improve access to care for sick and high risk newborns (such as premature babies);
- Improve quality of care for sick old children especially those who require a hospital admission;
- Increase the fight against malaria and malnutrition.
*** Blog By Associate Professor Peter Waiswa, the team leader Makerere University Centre for Maternal and Newborn Health Research.