In 2009, 4,821 pregnant women in Bbaale subcounty had at least one antenatal care visit at government health facilities. However, most mothers chose to deliver elsewhere. Only 27% chose to deliver in government health facilities deliveries and 11% chose private midwife deliveries. Most mothers were delivered either by traditional birth attendants (34%) or were presumed unattended (28%). Immediately after our education and training program was completed, a substantially greater proportion of mothers delivered at a government health facilities (52% vs. 27%) in the 16 subcounty villages where the village health secretaries visited and tracked pregnant woman in their community. However, 1 year later only 12 of these 16 elected village health secretaries continue to be active, in large part due to lack of ongoing Health District support.
By 2010, at the Kayunga District Hospital, the kangaroo mother care unit was admitting 25 mothers and their newborns per year. Admission of sick newborns, now cared for in the special neonatal room on the pediatric ward, increased 60%, compared with 2008, with a 93% survival rate. It was apparent that there was a sense of ownership of the program by the district, evidenced by the hospital now budgeting for equipment, supplies, and appropriate drugs for neonatal care services.
Conclusions
• High-risk newborn services are now well-integrated into Kayunga district health care system, including the community component, and Kayunga District Hospital is now an appropriate referral center for sick and premature newborns.
• Creating a partnership among existing community resources, locally active community-based organizations/NGOs, and government health systems is a cost-effective strategy to improve newborn care and to track newborn outcomes.
• Improvement in maternal and newborn outcomes requires a participatory approach by all stakeholders, and involves simultaneous provision of community-based education, skills training, and strengthening of government health facility capacity to supervise the community health care providers.
• Providing care for high-risk newborns at district hospitals is a critical component of strategies to improve neonatal and child survival.
• Traditional birth attendants provide almost half the nongovernmental delivery care, therefore the government should find a way of integrating their efforts into this process without compromising the quality of newborn care.
• Integrating multiple small funding sources can enable implementation of an effective, broad-based program for improvement of care for premature, sick, and high-risk newborns.
We would like to acknowledge Childhealth Advocacy International – Uganda staff, the Latter Day Saints Neonatal Resuscitation Training Program, International Community Access to Child Health/American Academy of Pediatrics (I-CATCH/AAP), Health Volunteers Overseas, Rotary International, Saving Newborn Lives, Uganda Women’s Health Initiative, National Newborn Steering Committee, Kayunga District Health team, Kayunga District Hospital management and staff, SEARCH Project-India, UNICEF, and the World Health Organization, and individuals who have inspired and supported us.
Dr. Nakakeeto-Kijjambu is a consultant pediatrician and neonatologist, and director of the Kampala Children’s Hospital Limited, and director of Childhealth Advocacy International – Uganda. Dr. Vaucher is a clinical professor of pediatrics and a neonatologist at the University of California, San Diego, a neonatology consultant at Makerere University, Mulago Hospital in Kampala, Uganda. She also is a pediatric volunteer with Health Volunteers Overseas, and is pediatric program director for Health Volunteers Overseas in Uganda. Others who helped in the writing of this article were Mary Kagolo, R.N., Ellen Milan, R.N., Monica Lyagoba, and Jane Frank Nalubega. Funding was integrated from diverse organizations including Saving Newborn Lives, UNICEF and the World Health Organization, the Latter Day Saints Resuscitation Training Program, Health Volunteers Overseas, Childhealth Advocacy International – Uganda, I-CATCH/AAP, Rotary International, each of which supported an activity appropriate for their primary purpose. The authors said they had no relevant financial disclosures.
*Correction 5/30/2012 changed maternal mortality to per 100,000 instead of per 1,000