Babies in Uganda still face many risks to their survival: pneumonia, malaria, and diarrhoea, to mention but a few.
However, being born prematurely (before 37 weeks of pregnancy) and its associated complications now accounts for a big toll of neonatal deaths (dying within the first 28 days of life).
Preterm births contribute 25 per cent (13 per 1,000 live births) of all neonatal deaths in the country, putting Uganda in the 28th position worldwide with the highest preterm deaths. Uganda loses 30,000 newborns annually.
Although many of these babies can survive with intensive neonatal care, it is not available in many health centres, especially those in the rural areas.
According to Prof Joy Lawn, a perinatal epidemiologist and director of Global Evidence and Policy for Gates Foundation, babies born prematurely are more susceptible to complications such as respiratory distress syndrome and infections like sepsis (blood infection), pneumonia and meningitis.
“To deal with preterm death, we’ll need convergence of maternal and child death prevention efforts. Low-cost interventions such as soap and water and pediatric antibiotics could dramatically reduce newborn mortality,” said Lawn. This was during the maternal and newborn conference at Serena hotel last week.
Other low-cost interventions include proper code care, encouraging mothers to go for antenatal checks and providing family planning services.
In Uganda, infant deaths have been falling since 1990 with recent acclaim being reduction from 76 deaths per 1,000 live births in 2006 to 54 per 1000 live births in 2011. However, the rate has since stagnated and it is apparent that the country has not achieved the millennium development goal four, target two.
This target focuses on achieving a two-third reduction in infant mortality to 31 deaths per 1,000 live births. The root causes for this stagnation, according to Dr Jane Ruth Aceng, the director general of ministry of Health, are limited human resource personnel, low community involvement and poor coordination of players in the field.
“Only 43 per cent of health worker posts are occupied in the country and specialists and midwives remain heavily wanted. Again, there are too many players running their own agenda in the field, which makes it difficult for the country to move towards a common goal,” said Aceng.
The experts also highlighted a number of social determinants affecting newborn mortality which need transformation such as poor maternal health and nutrition; limited education and access to health facilities; gender inequality and low coverage of reproductive health services such as family planning, among others.
“Although parity in school enrolment has been achieved, it has been frustrated by the school dropout rate. There is also an unfinished agenda on universal access to sexual and reproductive health rights as indicated by the maternal mortality rates,” said Dr Ismail Ndifuna, a senior programme specialist for sexual and reproductive health rights at UNFPA.
With the MDGs coming to an end in September, there is a new set of sustainable development goals (SDGs) with a 2030 target yet to be adopted.
SDG three mandates countries to reduce the maternal mortality ratio to less than 70 deaths per 100,000 live births and end preventable deaths of newborns and children under five by 2030.
The onus is also on countries to ensure universal access to sexual and reproductive health care and services including family planning and education by 2030.
“We need to improve the way we prioritise and invest our resources; not only considering the supply side, but also the demand side. We need to leverage the private sector to invest in health in order to improve the quality of services and reduce the patient burden,” said Dr Jesca Nsungwa, assistant commissioner, child health in the ministry of Health.