mothers and children first: innovation and research
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Mothers and children first: the results of the surveys conducted on coverage, quality and equity of health services in UgandaTRANSCRIPT
Doctors with Africa CuammMothers and Children First: the first steps - Uganda
National health statistics• 24.5% of the populationlives below the povertythreshold that correspondsto 1.25 USD per day.
• Maternal mortality rate is438 deaths every 100,000live births (5,000 maternaldeaths per year).
• The under five mortalityrate is 68 per 1,000 livebirths (103,000 deaths peryear)
• Neonatal mortality is 26 per
1,000 live births (total of39,000 deaths per year).
• Stillbirth is 25 per 1,000 livebirths (38,000 deaths peryear).
National health policies and data• Ratio of health personnel is14.3 per 10,000 inhabitants.
• The per capita healthexpenditure is 118 USD (inPPP).
• The National Health Plangives priority to the primaryhealthcare services andincludes a programme onsafe motherhood.
• The decentralisationprocess is on-going andincludes the strengtheningof maternal health units.
• A programme at nationallevel is being implementedthat reduces the duration ofthe training period andallows for a bigger numberof midwives to be trained.
Intervention in the District ofOyam and Aber Hospital • Population: 378,900inhabitants (approx. 18,000expected deliveries).
• Health facilities: n. 6peripheral maternal unitsand one hospital belongingto the diocese of Lira (200beds).
• Number of midwives: 37.• Expatriate personnel ofDoctors with Africa Cuamm:
n. 1 surgeon and n. 1paediatrician.
• At district level the followingservices have beenguaranteed: free transportand management ofobstetric emergencies,supply of equipment, drugsand capacity building oflocal human resources.
Tools:World Bank 2009Uganda Demographic Health Survey 2011World Health Statistics 2012
Uganda, Oyam District
Kotido
Oyam District
Yumbe
MarachaArua
Nyapea
Naggalama
NyengaKampala
NebbiMoroto
MatanyAngal
NkokonjeroNkozi
OyamDistrict, Uganda
1Parenteral administration of antibiotics
5Newborn resuscitation with mask and ambubag
6Parenteral administration of anticonvulsants
7Assisted vaginal delivery with vacuum or forceps
8Blood transfusion
9Cesarean section
2Parenteral administration of oxytocin
4Manual removal of placenta
3Removal of retained products of conception
Aber Hospital
Health Centre 1
Health Centre 2
Health Centre 3
Health Centre 4
Health Centre 5
Health Centre 6
Available serviceUnavailable service
– Services 1 - 7Basic essential obstetric and neonatal care / BEmOC Basic Emergency
– Services 1 - 9Comprehensive essential obstetric and neonatal care /CEmOC
Figure 1. Essential obstetric and neonatal emergency care1
1 Tool used: Need assessmentof emergency and neonatalcare, Columbia University,AMDD 2011.
Activities in 2012 (first year of implementation)
N. of skilled attened deliveries (over the expected in the District) 7,753 (42%)
N. of attended deliveries at Aber Hospital 2,151
N. of caesarean sections 445
Proportion of caesarean sections and number of expected births (5-15% standard)
2.4%
N. of ambulance emergency transports 172
N. of health personnel trained on obstetric and neonatal emergency 92
Direct obstetric case fatality rate(standard <1)
1.5%
Proportion of maternal deaths for indirect causes at hospital level 33%
Info: www.doctorswhithafrica.org
1.4Statistics
2Availability of drugs
1.25Availability of equipment and consumables
1Laboratory diagnostics availability
1Infrastructure
1.25Maternal unit
0.6Nursery Unit
1.3Normal labour
1.6Cesarean Sections
1.57Management of maternal complications
1.3Routine neonatal care
0.9Sick newborn care
1.52Management of emergencies1.9
1.6Monitoring and follow up
0.9Guidelines and auditing procedures
1.4Access to hospital healthcare Aber
Hospital Uganda
Infection control and supportive care
0 - 0.9 Sustantial improvements are needed in order to avoid serious threats to mothers and newborn health.
1 - 1.9Improvements are necessary in order to avoid risks for women and newborn.
2 - 3 Improvements are needed in order to minimize potential threats to health of mothers and newborns while respecting their dignity and rights.
2
8 8
2
43
20
77
40
– 77% of women t
–
Qu
inti
le 1
Qu
inti
le 2
Qu
inti
le 3
Qu
inti
le 4
Qu
inti
le 5
0%
20%
40%
60%
80%
100%
poorest wealthiest
–
Health centre
Hospital
– 77% of women that give birth at Aber Hospital belong to the wealthiest quintile none of them to the poorest quintiles.
– 40% of women that
give birth in Health Centres belong to the wealthiest quintile and only 6% to poorest quintiles.
P
Doctors with Africa CuammMothers and Children First: the first steps - Uganda
Figure 2. Quality of mother and neonatal healthcare services2
Figure 3. Socio-economic profile of women delivering at hospital level and health centres at district level3
2 Tool used: Assessment tool forthe quality of hospital care formothers, newborn and child,WHO 2009.
3 Tool used: Proxy Wealth Index,Demographic Health Survey Uganda2006.
Info: www.doctorswhithafrica.org