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The Right Training Has Led to 100% Survival for Preterm Babies at this Ugandan Hospital

The BABIES matrix is a simplified quality-improvement methodology for collecting and displaying data. It was introduced and implemented by the Katakwi Hospital to improve services. Photo courtesy of Irene Mirembe.

This midwife is giving babies born too soon a chance at life.

Margret Imma from Uganda’s Katakwi District looks lovingly at her 4-month-old, bubbly baby boy, Orisa. He is glowing and Margret couldn’t be happier. This was not the case a few months ago, when Orisa was born too soon.

“The pain and suffering that came with handling a preterm baby was unbearable,” Margret says. “I was worried he would not survive.”  

Complications from preterm birth account for nearly 1 million deaths each year. Without a major push to reduce them, we will not end preventable newborn and child deaths by 2030, which is a global goal that has been endorsed by 193 countries.

The demands from the children’s ward are overwhelming. We receive so many mothers in distress.

Katakwi district, in the eastern corner of Uganda, grapples with high disease burden. The most vulnerable are young mothers like Margret because there aren't enough health workers to meet the high demand for services, including life-threatening childbirth emergencies. The district hospital serves 38,000 people from across eight sub-counties and is a referral point for many coming through the Karamoja region.

“The demands from the children’s ward are overwhelming,” says Dr. Opus Benjamin, acting medical superintendent at the Katakwi Hospital. “We receive so many mothers in distress and must provide quality care every day.”

The hospital needed more trained staff to provide basic quality care when and where it was needed, so that babies born too soon would have a chance to live. So, they brought in Catherine Alinga, a trained midwife. Senior Catherine, as she is fondly called by many at the maternity ward, works with the IntraHealth International-led Regional Health Integration to Enhance Services in Eastern Uganda (RHITES-E) project to improve the quality of care for mothers and preterm babies.

In March 2019, Catherine began training staff at the Katakwi Hospital on helping babies breathe techniques and neonatal care. She also mentored the entire maternity staff at Katakwi and lower-level facilities on kangaroo mother care and newborn care.

Margret’s baby is alive today thanks to Catherine and the midwives she trained. Catherine’s skills and efforts showcase how hospitals in rural areas have found workable solutions to prevent newborn deaths.

Before Catherine’s training, the survival rate for preterm births was less than 10%, as many babies referred from lower facilities were at risk of dying on their way to Katakwi General Hospital. Since Catherine’s trainings, though, the unit has saved 15 premature babies, including Orisa. In the month of October alone, seven premature babies were admitted. All have been discharged alive.

To achieve this feat, the hospital developed a standard operating procedure for referrals and displayed it at facilities that were sending in most cases. Now, staff at local hospitals know when to refer mothers who are in need for care to the general hospital and staff at the general hospital are prepared to care for referred mothers when they arrive at the maternity ward.

The survival rate of preterm babies improved  from 73% to 100% in 2019.

The survival rate of preterm babies improved at Katakwi hospital from 73% in June 2019 to 80% in September 2019— and then to 100% in October 2019.

“The team here has been trained in handling premature babies, in terms of infection control, prevention of hypothermia, drug administration, dosages, frequency, and dilution,” Catherine says. “These are crucial and lifesaving steps that make a difference in the death or survival of a preterm baby.”

The maternity unit also encourages mothers to practice kangaroo mother care as one of the prevention measures to keep the baby warm and suggests that male partners participate in this care as well. The father’s participation in the baby’s post-birth care has ensured the survival of babies long after they have been discharged back into the community.

“Right now, the unit is on top of its game and the hospital administration is doing its very best to make sure equipment, drugs, and systems are in place to ensure all preterm babies survive,” says Geoffrey Orijabo, senior technical officer for maternal newborn and child health / family planning for RHITES-E .

The Regional Health Integration to Enhance Services in Eastern Uganda (RHITES-East) program is led by IntraHealth International and funded by the US Agency for International Development.

November 17, 2019, is World Prematurity Day. You can follow the campaign online using #PrematurityAwarenessMonth, #WorldPrematurityDay and #ItsNotFine