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Strengthening Health Facilities for Maternal Newborn Care: experiences from rural eastern Uganda Authors: G Namazzi, P. Waiswa, S. Peterson R. Byaruhanga,

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Presentation on theme: "Strengthening Health Facilities for Maternal Newborn Care: experiences from rural eastern Uganda Authors: G Namazzi, P. Waiswa, S. Peterson R. Byaruhanga,"— Presentation transcript:

1 Strengthening Health Facilities for Maternal Newborn Care: experiences from rural eastern Uganda Authors: G Namazzi, P. Waiswa, S. Peterson R. Byaruhanga, et al

2 The Uganda health care system Village/Home (Village health team, CHWs) Primary Health Centers (HC levels II to IV) Hospitals (district, regional & national) 2 ≈ 14,000 HC ≈ 100 Hospitals≈ 55,000 villages  33 million people  Total fertility rate 6.7/woman  57% deliver in a health facility  MMR=438/100,000 live births  NMR= 27/1,000 live births (38,000 newborn deaths annually) plus similar number of stillbirths 72% population in 5 Km of a health facility – but most do not provide newborn care

3 Objective of the study This study was part of the Uganda Newborn Study (UNEST) a cluster-randomised control trial testing an integrated community-facility package Facility intervention aimed to increase frontline health worker capacity at one district hospital and 19 lower level facilities to improve health outcomes for mothers and newborn babies in Iganga /Mayuge DSS

4 Methods District-led training, support supervision and mentoring addressing the main causes of maternal and newborn death Supported use of partographs (previously used poorly or not at all) Introduced care for small and sick babies Introduced maternal and perinatal death review Once-off provision of basic equipment, medicines & supplies 2 midwives received extra training at national special care unit for hands-on experience in care of high risk babies Identified local champions/mentors for newborn care to support ongoing uptake

5 Results: Knowledge and skills building 72 % of targeted frontline health workers trained Mean pre-training score was 32% vs 68% post training After one year, mean score was 80%. Midwives were able to confidently resuscitate newborns, pass nasogastric tubes and IV cannulas Kangaroo Mother Care for preterm babies training and unit established

6 Utilization and care practices Health facility delivery increased by 27% (from 2700 to 3435, larger than the increase in births in the districts) 547 preterm babies were admitted to Kangaroo Care, 85% were discharged alive 249 sick newborn babies were admitted on the paediatric unit; with 75% survival rate Bathing within 6 hrs decreased from 56% to 20% although almost all bathed within 24 hours Immediate initiation of breastfeeding increased from 52% to 80%

7 Maternal and Perinatal mortality In-hospital maternal deaths reduced during the study period and sustained decreases even beyond the study period In-hospital perinatal mortality reduced from 65/1000 at baseline to 50/1000 live births in 2013

8 Challenges Contextual issues e.g. lack of accommodation for staff, constraining availability of 24/7 services for some lower level facilities Maintaining supply of even the most basic medications was a challenge with less than 40% of health facilities reporting no stock-outs Avoidable factors identified through mortality audit were difficult to address especially at administrative/ managerial and community level Incompleteness of HMIS records hampered accountability and process documentation

9 Conclusion Through a participatory process with wide engagement, improvements to training, support supervision and logistics, health workers were able to change behaviours and practices for maternal and newborn care. Addressing quality of care bottlenecks is a significant challenge and further innovative solutions are needed for resource constrained settings in order to save the lives of mothers and babies and help them thrive.


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