Brenda Lakisa together with Dr. Miriam Ajambo, Medical officer at Gulu RRH neonatal unit during a community follow up visit to baby Precious at 4 months of age. Photo credit: URC

At age 23, Brenda Lakisa, from Gulu district had suffered five miscarriages starting with her first pregnancy at age 18. Although her third and fourth pregnancies were delivered at hospitals, the preterm babies did not survive. “Whenever the baby was born, the nurse cut the umbilical cord and placed it aside without tying the cord. The baby died hours later,” says Lakisa.

In the last three decades, the rate of newborn deaths in Uganda has remained at 27 per 1,000 live births. A baseline assessment of newborn care services conducted by the RHITES-North -Activity in eight districts of Acholi in 2018 showed that prematurity (25%), birth asphyxia (16%), and sepsis (15%) were the leading causes of neonatal mortality. Only two of the region’s 25 high-volume facilities had a dedicated space to treat newborns and health workers lacked the knowledge and skills to manage newborn conditions.

The Ministry of Health’s Newborn Steering Committee and URC’s USAID Regional Health Integration to Enhance Services in North, Acholi Activity (RHITES-N. Acholi) partnered to establish functional neonatal care units (NCUs) for sick and premature infants in all Acholi districts. Under the initiative, eight district health leaders and 15 facility managers from six hospitals, visited the model Neonatal Intensive Care Unit at Kiwoko Hospital in Nakaseke district. The leaders committed to setting up nurseries at their facilities. Four medical officers, one clinical officer, and 16 midwives/nurses worked at the Kiwoko NICU for one week for hands-on learning.

The supported facilities identified dedicated space for NCUs. The team conducted equipment and supplies training, printed and distributed neonatal care protocols and guidelines, and defined clear admission and referral criteria for each newborn level of care. High-level facilities continued to mentor lower-level facilities and used quality improvement cycles, documentation, and quarterly learning sessions to address the top three causes of newborn mortality. A WhatsApp group served as a platform for learning, coordination, and management support.

The results have been impressive. Institutional pre-discharge neonatal deaths decreased from 23% in October 2018 to 9% in May 2019. And there was a notable overall 85% increase in admissions at the 13 facilities. Kangaroo care of placing babies chest-to-chest with mothers or fathers to promote bonding, early breastfeeding, and to help regulate infant body temperature, improved from 20% in November 2018 to 80% in May 2019.

With the sixth pregnancy, Lakisa’s fortune changed. On March 28, 2019 she gave birth at 26 weeks to a pre-term baby named Precious, weighing 0.8kgs. Lakisa learned to practice kangaroo care, how to express breast milk to feed her daughter, and other healthy baby care practices, with regular support from the hospital’s health workers and her mother. Through her two-month long stay at the hospital, Lakisa became a peer mother, providing support to other mothers with sick and pre-term babies. Precious was discharged, weighing 1.2kgs, still on kangaroo care and able to breastfeed. For two months post-discharge, Precious received bi-weekly check-ups at the hospital.  by the end of this period, she weighed 2.5kgs.

Despite the successes, the facilities still face challenges including inadequate care for extremely low birth weight infants and creation of a critical mass of NCU-specific staff, crucial for the survival of neonates. In the coming year, RHITES-N. Acholi and the Ministry of Health will operationalize 63 basic NCUs at health centers as they continue to strengthen community referral and care structures.