Newborn HealthNewborn HealthKiwoko, Luwero District, Kiwoko, Luwero District,

UgandaUganda

EPI/HSERV 544 – Maternal/Child Health in EPI/HSERV 544 – Maternal/Child Health in Developing CountriesDeveloping Countries

January 23January 23rdrd, 2007, 2007Maneesh Batra, MD MPHManeesh Batra, MD MPH

Setting - UgandaSetting - Uganda

Population - 2.3 million, 84% ruralPopulation - 2.3 million, 84% rural Languages - English, Luganda, Languages - English, Luganda,

SwahiliSwahili Literacy Rate – 69%male, 59%femaleLiteracy Rate – 69%male, 59%female Per capita GNP - $310Per capita GNP - $310 Fertility rate – 7.1 (5Fertility rate – 7.1 (5thth in world) in world) NMR – 33.1/1000 live birthsNMR – 33.1/1000 live births IMR – 88.3/1000 live birthsIMR – 88.3/1000 live births U5MR – 151.5/1000 live birthsU5MR – 151.5/1000 live births MMR – 880/100,000 live birthsMMR – 880/100,000 live births Malnourished Children - 26%Malnourished Children - 26% Life expectancy - 42 yearsLife expectancy - 42 years

Setting – Luwero Setting – Luwero DistrictDistrict

Setting – Luwero Setting – Luwero DistrictDistrict

Area: 5773.53 sq. kmArea: 5773.53 sq. km Population: 492,184 (proj. Population: 492,184 (proj.

2000)2000) 91.1% rural91.1% rural 8.1% urban 8.1% urban

Pop. Growth Rate: 2.3 % Pop. Growth Rate: 2.3 % per yr.per yr.

Avg. size household: 5Avg. size household: 5 Population within 5 km of a Population within 5 km of a

health services unit: 53%.health services unit: 53%. Doctors to Population RatioDoctors to Population Ratio

1:23,438 1:23,438 16 doctors in the district16 doctors in the district

Setting – Luwero Setting – Luwero DistrictDistrict

Immunization Coverage: Immunization Coverage: 46%46%

IMR: 112/100,000 live IMR: 112/100,000 live birthsbirths

U5MR: 150/1000 live birthsU5MR: 150/1000 live births Stunting Rate: 36%Stunting Rate: 36% Acute Malnutrition: 7%Acute Malnutrition: 7% Antenatal Care Antenatal Care

ANC attendance rate: 75 %ANC attendance rate: 75 % Delivery by trained staff: 36 %Delivery by trained staff: 36 %

Access to Safe Water: 42%Access to Safe Water: 42% Latrine Coverage: 54%Latrine Coverage: 54%

Kiwoko HospitalKiwoko Hospital Early 1990s - Abandoned Early 1990s - Abandoned

school turned into a health school turned into a health clinic by Dr. Ian Clarkeclinic by Dr. Ian Clarke

One of 3 hospitals in the One of 3 hospitals in the districtdistrict

4 full time doctors 4 full time doctors Serves population of Serves population of

500,000500,000 Treats 25,000 people per Treats 25,000 people per

yearyear 1000 deliveries per year1000 deliveries per year 1500 operations per year1500 operations per year Most patients arrive by Most patients arrive by

foot foot or bicycleor bicycle

Kiwoko HospitalKiwoko Hospital

Kiwoko HospitalKiwoko Hospital 150-250 beds150-250 beds 8 wards (Peds, Malnutrition, Male, Female, 8 wards (Peds, Malnutrition, Male, Female,

Surgical, TB, Maternity, NICU)Surgical, TB, Maternity, NICU) Outreach/EducationOutreach/Education

Kiwoko Hospital - Kiwoko Hospital - ResourcesResources

Majority of care by Majority of care by family membersfamily members

Sporadic electricitySporadic electricity Rain + well waterRain + well water Limited vaccine supplyLimited vaccine supply

BCG, DTP, Td, Measles, BCG, DTP, Td, Measles, OPVOPV

Limited laboratoryLimited laboratory Limited medication Limited medication

supplysupply Limited blood supplyLimited blood supply

Kiwoko Hospital - NICUKiwoko Hospital - NICU

Built by ISIS, opened in 1999Built by ISIS, opened in 1999

Kiwoko Hospital - NICUKiwoko Hospital - NICU

Primary Diagnoses: Primary Diagnoses: LBW, Sepsis, Tetanus, Malaria, Meningitis, LBW, Sepsis, Tetanus, Malaria, Meningitis,

Asphyxia, Meconium Aspiration, Respiratory Asphyxia, Meconium Aspiration, Respiratory DistressDistress

Kiwoko Hospital - NICUKiwoko Hospital - NICU

20 beds, 3 functioning incubators20 beds, 3 functioning incubators ½ of admissions inborn½ of admissions inborn Overall Mortality 20-30%Overall Mortality 20-30% Tetanus Mortality 80-90%Tetanus Mortality 80-90%

Why do babies die in Why do babies die in Luwero?Luwero?

At HomeAt Home

Largely unknown Largely unknown magnitude and scope magnitude and scope of problemof problem

Barriers to seeking Barriers to seeking carecare

KnowledgeKnowledge $$$$$$$$$$$$$$$$$$ Impact on family unitImpact on family unit What if the baby dies? What if the baby dies?

Why do babies die in Why do babies die in Luwero?Luwero?

In the HospitalIn the Hospital In-bornIn-born

LBWLBW SepsisSepsis AsphyxiaAsphyxia

Out-bornOut-born Delayed presentationDelayed presentation LBWLBW Sepsis, Meningitis, Skin Sepsis, Meningitis, Skin

infectionsinfections TetanusTetanus ? Etiology? Etiology

Majority present with non-Majority present with non-specific signsspecific signs

Improving Newborn Improving Newborn OutcomesOutcomes

FrameworkFramework

AntenatalAntenatal Antenatal careAntenatal care

ImmunizationImmunization Malaria Malaria

treatmenttreatment Maternal Maternal

nutritionnutrition Birth spacingBirth spacing

Improving Newborn Improving Newborn OutcomesOutcomes

FrameworkFramework PeripartumPeripartum

Skilled birth Skilled birth attendantattendant

Immediate newborn Immediate newborn carecare

Obstetric Obstetric emergenciesemergencies

Improving Newborn Improving Newborn OutcomesOutcomes

FrameworkFramework PostpartumPostpartum

Recognition of Recognition of illnessillness

Appropriate initial Appropriate initial stabilization and stabilization and referralreferral

Nutritional Nutritional management of management of LBWLBW

NICU careNICU care

Thanks!Thanks!