1. Newborn Health Kiwoko, Luwero District, Uganda EPI/HSERV 544 – Maternal/Child Health in Developing Countries January 23 rd, 2007 Maneesh Batra, MD MPH

2. Setting - Uganda Population - 2.3 million, 84% rural Population - 2.3 million, 84% rural Languages - English, Luganda, Swahili Languages - English, Luganda, Swahili Literacy Rate – 69%male, 59%female Literacy Rate – 69%male, 59%female Per capita GNP - $310 Per capita GNP - $310 Fertility rate – 7.1 (5 th in world) Fertility rate – 7.1 (5 th in world) NMR – 33.1/1000 live births NMR – 33.1/1000 live births IMR – 88.3/1000 live births IMR – 88.3/1000 live births U5MR – 151.5/1000 live births U5MR – 151.5/1000 live births MMR – 880/100,000 live births MMR – 880/100,000 live births Malnourished Children - 26% Malnourished Children - 26% Life expectancy - 42 years Life expectancy - 42 years

3. Setting – Luwero District

4. Area: 5773.53 sq. km Area: 5773.53 sq. km Population: 492,184 (proj. 2000) Population: 492,184 (proj. 2000) 91.1% rural 91.1% rural 8.1% urban 8.1% urban Pop. Growth Rate: 2.3 % per yr. Pop. Growth Rate: 2.3 % per yr. Avg. size household: 5 Avg. size household: 5 Population within 5 km of a health services unit: 53%. Population within 5 km of a health services unit: 53%. Doctors to Population Ratio Doctors to Population Ratio 1:23,438 1:23,438 16 doctors in the district 16 doctors in the district

5. Setting – Luwero District Immunization Coverage: 46% Immunization Coverage: 46% IMR: 112/100,000 live births IMR: 112/100,000 live births U5MR: 150/1000 live births U5MR: 150/1000 live births Stunting Rate: 36% Stunting Rate: 36% Acute Malnutrition: 7% Acute Malnutrition: 7% Antenatal Care Antenatal Care ANC attendance rate: 75 % ANC attendance rate: 75 % Delivery by trained staff: 36 % Delivery by trained staff: 36 % Access to Safe Water: 42% Access to Safe Water: 42% Latrine Coverage: 54% Latrine Coverage: 54%

7. Kiwoko Hospital Early 1990s - Abandoned school turned into a health clinic by Dr. Ian Clarke Early 1990s - Abandoned school turned into a health clinic by Dr. Ian Clarke One of 3 hospitals in the district One of 3 hospitals in the district 4 full time doctors 4 full time doctors Serves population of 500,000 Serves population of 500,000 Treats 25,000 people per year Treats 25,000 people per year 1000 deliveries per year 1000 deliveries per year 1500 operations per year 1500 operations per year Most patients arrive by foot Most patients arrive by foot or bicycle

8. Kiwoko Hospital

9. 150-250 beds 150-250 beds 8 wards (Peds, Malnutrition, Male, Female, Surgical, TB, Maternity, NICU) 8 wards (Peds, Malnutrition, Male, Female, Surgical, TB, Maternity, NICU) Outreach/Education Outreach/Education

11. Kiwoko Hospital - Resources Majority of care by family members Majority of care by family members Sporadic electricity Sporadic electricity Rain + well water Rain + well water Limited vaccine supply Limited vaccine supply BCG, DTP, Td, Measles, OPV BCG, DTP, Td, Measles, OPV Limited laboratory Limited laboratory Limited medication supply Limited medication supply Limited blood supply Limited blood supply

13. Kiwoko Hospital - NICU Built by ISIS, opened in 1999

14. Kiwoko Hospital - NICU Primary Diagnoses: LBW, Sepsis, Tetanus, Malaria, Meningitis, Asphyxia, Meconium Aspiration, Respiratory Distress LBW, Sepsis, Tetanus, Malaria, Meningitis, Asphyxia, Meconium Aspiration, Respiratory Distress

15. Kiwoko Hospital - NICU 20 beds, 3 functioning incubators 20 beds, 3 functioning incubators ½ of admissions inborn ½ of admissions inborn Overall Mortality 20-30% Overall Mortality 20-30% Tetanus Mortality 80-90% Tetanus Mortality 80-90%

16. Why do babies die in Luwero? At Home Largely unknown magnitude and scope of problem Largely unknown magnitude and scope of problem Barriers to seeking care Barriers to seeking care Knowledge Knowledge $$$$$$$$$ $$$$$$$$$ Impact on family unit Impact on family unit What if the baby dies? What if the baby dies?

17. Why do babies die in Luwero? In the Hospital In-born In-born LBW LBW Sepsis Sepsis Asphyxia Asphyxia Out-born Out-born Delayed presentation Delayed presentation LBW LBW Sepsis, Meningitis, Skin infections Sepsis, Meningitis, Skin infections Tetanus Tetanus ? Etiology ? Etiology Majority present with non- specific signs Majority present with non- specific signs

18. Improving Newborn Outcomes Framework Antenatal Antenatal Antenatal care Antenatal care Immunization Immunization Malaria treatment Malaria treatment Maternal nutrition Maternal nutrition Birth spacing Birth spacing

19. Improving Newborn Outcomes Framework Peripartum Peripartum Skilled birth attendant Skilled birth attendant Immediate newborn care Immediate newborn care Obstetric emergencies Obstetric emergencies

20. Improving Newborn Outcomes Framework Postpartum Postpartum Recognition of illness Recognition of illness Appropriate initial stabilization and referral Appropriate initial stabilization and referral Nutritional management of LBW Nutritional management of LBW NICU care NICU care

22. Thanks!