Health system preparedness for newborn care: a health facility assessment in rural Uganda

Nalwadda, Christine; Peterson, Stefan; Tomson, Göran; Guwatudde, David; Kiguli, Juliet; Namazzi, Gertrude; Namutamba, Sarah; Namugaya, Faith; Nambuya, Harriet; Tagoola, Abner; Waiswa, Peter

doi:10.1186/1472-6963-14-s2-p63

Cited by 3 publications

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“…However, to ensure that newborns benefit from NR, essential equipment, medical supplies, need to be made available and ready at the right place for the right application of the procedure [19]. When health facilities are performing low on the availability and readiness measures for NR service, they cannot meet the practice and quality standards [20] and the potential health benefits of NR practice to newborns becomes compromised.…”

Section: Discussionmentioning

confidence: 99%

Quality of neonatal resuscitation in Ethiopia: implications for the survival of neonates

et al. 2020

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Background: Birth asphyxia accounts for one-quarter newborn deaths. Providing quality care service of neonatal resuscitation reduces neonatal mortality. However, challenges to providing quality neonatal resuscitation are not well investigated in Ethiopia. Hence, this study is conducted to assess the quality provision of neonatal resuscitation in Ethiopia. Method: We used data from the Ethiopian 2016 Emergency Obstetric Newborn Care survey, conducted in 3804 health facilities providing maternal and newborn health services. We described the quality of neonatal resuscitation services according to the structure, process and outcome triad of quality dimension. Data from registers and birth records for the last 12 months prior to the survey were extracted. In each facility, the three last eligible charts of resuscitated neonates were reviewed and the highest frequency of chart of resuscitated baby was considered to the analysis. Thus, a total of 555 charts were assessed. Logistic regression model was used to assess the relationship between the neonatal resuscitation processes, provider, facility and newborn characteristics with neonatal outcome at the time of discharge. Results: The finding suggested that, around two-third, 364(65.6%) of the asphyxiated babies resuscitated by bag and mask type of neonatal resuscitation. Of the babies who had got neonatal resuscitation 463 (83.4%) survived. Resuscitated neonates with a gestational age of greater than 37 weeks and above (Adjusted Odds Ratio (AOR) =1.82; 95% Confidence Interval (CI) (1.09-3.04)), availability of priority equipment in health facilities for neonatal resuscitation (AOR = 1.24, 95% CI (1.09, 1.54)) and women who had 12 h and less duration of labor (AOR = 1.76; 95% CI (1.23, 3.13)) were the independent factors of survival of the neonate. Conclusion: Only half of the health facilities were ready for neonatal resuscitation (NR) in terms of priority equipment's. However, eight out of ten babies survived after NR in Ethiopia. Gestational age, priority equipment for NR and duration of labor were determinants of survival of resuscitated neonates in Ethiopia. Therefore, the availability of priority equipment and attentive care and follow-up for premature neonates and those face prolonged labor need to be improved in Ethiopia.

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Section: Discussionmentioning

confidence: 99%

Quality of neonatal resuscitation in Ethiopia: implications for the survival of neonates

et al. 2020

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“…This could potentially be due to the specialised care available at higher-level facilities, which may encourage people with serious conditions to seek care at these facilities first, or be referred there. Nalwadda et al [ 31 ] reported that the availability of newborn sepsis drugs at HC IIs (8%) was much lower than it was for HC IIIs (67%), or HC IVs and hospitals (75%).…”

Section: Discussionmentioning

confidence: 99%

Trends and spatial distribution of neonatal sepsis, Uganda, 2016–2020

Migamba,

Kisaakye,

Komakech

et al. 2023

BMC Pregnancy Childbirth

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Background In Uganda, sepsis is the third-leading cause of neonatal deaths. Neonatal sepsis can be early-onset sepsis (EOS), which occurs ≤ 7 days postpartum and is usually vertically transmitted from the mother to newborn during the intrapartum period, or late-onset sepsis (LOS), occurring 8–28 days postpartum and largely acquired from the hospital environment or community. We described trends and spatial distribution of neonatal sepsis in Uganda, 2016–2020. Methods We conducted a descriptive incidence study using routinely-reported surveillance data on in-patient neonatal sepsis from the District Health Information System version 2 (DHIS2) during 2016–2020. We calculated incidence of EOS, LOS, and total sepsis as cases per 1,000 live births (LB) at district (n = 136), regional (n = 4), and national levels, as well as total sepsis incidence by health facility level. We used logistic regression to evaluate national and regional trends and illustrated spatial distribution using choropleth maps. Results During 2016–2020, 95,983 neonatal sepsis cases were reported, of which 71,262 (74%) were EOS. Overall neonatal sepsis incidence was 17.4/1,000 LB. EOS increased from 11.7 to 13.4 cases/1,000 LB with an average yearly increase of 3% (p < 0.001); LOS declined from 5.7 to 4.3 cases/1,000 LB with an average yearly decrease of 7% (p < 0.001). Incidence was highest at referral hospitals (68/1,000 LB) and lowest at Health Center IIs (1.3/1,000 LB). Regionally, total sepsis increased in Central (15.5 to 23.0/1,000 LB, p < 0.001) and Northern regions (15.3 to 22.2/1,000 LB, p < 0.001) but decreased in Western (23.7 to 17.0/ 1,000 LB, p < 0.001) and Eastern (15.0 to 8.9/1,000, p < 0.001) regions. Conclusion The high and increasing incidence of EOS in Uganda suggests a major gap in sepsis prevention and quality of care for pregnant women. The heterogenous distribution of neonatal sepsis incidence requires root cause analysis by health authorities in regions with consistently high incidence. Strengthening prevention and treatment interventions in Central and Northern regions, and in the most affected districts, could reduce neonatal sepsis. Employment of strategies which increase uptake of safe newborn care practices and prevent neonatal sepsis, such as community health worker (CHW) home visits for mothers and newborns, could reduce incidence.

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Caring for children with neurodevelopmental disability: Experiences from caretakers and health workers in rural eastern Uganda

et al. 2020

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Background Long term outcomes of children with neurodevelopmental disability are influenced by the condition itself, available health services and caretakers' coping ability to nurture the children which may be related to their beliefs and experiences. Most children with neurodevelopmental disabilities live in resource constrained settings. To inform design of contextually appropriate interventions, this study explored health workers' and caretakers' experiences in caring for infants with neurodevelopmental disability in rural eastern Uganda. Methods A qualitative case study was carried out in December 2017 and involved in-depth interviews with 14 caretakers of infants with severe neurodevelopmental disability, and five health workers in Iganga/Mayuge Demographic Surveillance Site in eastern Uganda. The interviews with caretakers were conducted in Lusoga, the local language, and in English for the health workers, using a predetermined open-ended interview guide. Data were analyzed using latent content analysis. Results Caretakers described the experience of caring for children with neurodevelopmental disability as impoverishing and 'imprisoning' due to high care costs, inability to return to income generating activities and nursing challenges. The latter resulted from failure in body control and several aspects of nutrition and maintaining vital functions, coupled with limited support from the community and the health system. Many caretakers expressed beliefs in supernatural causes of neurodevelopmental disability though they reported about complications

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Health system preparedness for newborn care: a health facility assessment in rural Uganda

Cited by 3 publications

References 0 publications

Quality of neonatal resuscitation in Ethiopia: implications for the survival of neonates

Quality of neonatal resuscitation in Ethiopia: implications for the survival of neonates

Trends and spatial distribution of neonatal sepsis, Uganda, 2016–2020

Caring for children with neurodevelopmental disability: Experiences from caretakers and health workers in rural eastern Uganda

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