For decades, kangaroo care sessions of skin-to-skin contact between newborns and parents has been shown to improve the physical and neurological health of premature babies. PHOTO | OLBIOS.ORG
Uganda is among the countries facing high rates of preterm births, a pressing public health issue that affects infants and their families. According to the World Health Organisation (WHO), Uganda records approximately 226,000 preterm births annually, ranking among the sub-Saharan African countries with the highest preterm birth rates.
In Uganda, the high incidence of preterm births places immense pressure on the country's healthcare system. Neonatal Intensive Care Units (NICUs) are scarce and often under-resourced, particularly in rural hospitals. Many healthcare facilities lack critical equipment such as incubators, ventilators and essential medications, leaving preterm infants highly vulnerable to infections, respiratory distress, and complications such as hypothermia.
Despite efforts to address these challenges, only 25 percent of Uganda's districts have at least one WHO-recommended newborn care unit. This is significantly below the targets outlined in the Sustainable Development Goals (SDGs) for reducing neonatal mortality.
Nakato's Journey
Prossy Nakato's experiences with childbirth have been a mix of joy, challenges, and triumphs. Her first baby was born at full term without complications. However, her second pregnancy took a different turn. At six months, she was diagnosed with gestational diabetes. Despite the doctors' efforts to manage her condition, complications arose, and her baby had to be delivered prematurely, weighing just 900 grammes.
The baby was admitted to the Neonatal Intensive Care Unit (NICU), while Nakato was discharged after three days. Leaving the hospital without her baby was an incredibly painful experience.
“I cried a lot. I was in pain after the C-section and had to pump milk every day to take to the hospital. The baby was so tiny, and I was terrified,” she recalls.
Nakato practised kangaroo care, a skin-to-skin method that helps premature babies thrive. Over time, her baby gained enough strength to suckle directly from her breast. After a month in the NICU, they were finally discharged. Today, that baby is a healthy eight-year-old boy.
Her third pregnancy also ended in a premature birth. At seven months, Nakato experienced false labour, which intensified despite medical interventions. Because she had already given birth via C-section, her gynaecologist recommended delivering the baby.
This time, her premature baby weighed 1.5 kilogrammes and required only two weeks in the NICU. With prior experience, Nakato felt more prepared. She followed strict hygiene precautions and adhered to social isolation to protect her baby from infections. Although the baby was initially fed through a tube, Nakato transitioned her to breastfeeding, and she grew quickly. Today, she is a thriving five-year-old.
Despite the challenges, Nakato emphasises how delicate premature babies are. “You cannot trust anyone else to care for them. Their immune systems are weak, and they fall sick easily. Only you truly understand the instructions from the doctor,” she says.
Neumbe’s story of commitment
Lorna Neumbe woke up in a pool of blood in the middle of the night. Alarmed, she called her husband, who was on night duty. He rushed her to a nearby hospital, where doctors determined they could not handle the situation due to her baby being premature. She was quickly referred to International Hospital Kampala (IHK).
Having lost a significant amount of blood, doctors warned of the high risk of losing either Lorna or the baby. She was immediately rushed to the theatre, and her baby was delivered alive.
While Lorna recovered at IHK, her baby, under the care of her husband, faced additional challenges as the couple's medical insurance was depleted. This forced them to transfer the baby to Naguru Hospital in Kampala, which offered more affordable care.
Despite the separation, the father ferried Lorna’s expressed breast milk daily to the NICU. The combination of kangaroo care by the father and breast milk was pivotal to the baby’s recovery. Today, their only concern is the baby's weak immune system, a common condition for preterm infants.
Ajiet’s story of generosity
Eight months ago, Marcellinious Ajiet’s wife gave birth to a premature baby. Shortly after delivery, the mother struggled to produce milk, and the doctors recommended formula. Unfortunately, the baby vomited after every feeding.
Eventually, the mother began producing more than enough milk, even exceeding her baby's needs. The surplus milk was being discarded when a doctor suggested donating it to help other preterm infants.
Ajiet agreed, and his wife began pumping and donating milk to support a pair of preterm twins whose mother had passed away. Even after leaving the NICU a month later, the couple continued donating milk until the twins were three months old.
Tusabaomu: Preterm babies
Flavia Tusabaomu is a mother of two who has faced the challenges of preterm births twice. Her first pregnancy was complicated by a large fibroid and high blood pressure, leading to the delivery of her baby at just 34 weeks. Born weighing 1.5 kg, the baby required significant care. Initially overwhelmed, Flavia learnt to express breast milk and practised kangaroo care, which helped her baby thrive.
Despite her fears of another premature birth, Flavia conceived again after reassurances from her doctors. However, her second pregnancy also brought complications, including high blood pressure and swelling at 29 weeks. Delivered at 30 weeks and weighing 1.4 kg, her second baby required extensive care.
This time, Flavia felt more prepared, drawing on her prior experience and her family’s support of her family. A breastfeeding cousin donated milk to boost Flavia’s supply. Today, her second preterm baby is a healthy three-year-old, free from any complications.
Understanding preterm births
Dr Patrick Baingana, a team leader at the neonatal ICU at C-Care, defines a preterm birth as one where a baby is born before 37 weeks of pregnancy. Preterm babies are categorised based on their gestational age and birth weight:
Extreme prematures are born before 28 weeks, often weighing less than one kilogramme.
while late preterms are born between 34 and 37 weeks, typically weighing more than 1.5 kilogrammes.
Babies born before 28 weeks are particularly challenging to manage. They usually require prolonged hospital stays and significant medical support.
Causes
Preterm births can result from various pregnancy complications, including high blood pressure, premature rupture of membranes (water breaking early), uterine weakness, infections or malaria and carrying multiple babies.
In such cases, doctors counsel mothers and families about the physical, emotional, and financial demands of managing preterm births. The care process begins even before delivery.
Preparing for a preterm baby
Before delivery, mothers are often given corticosteroid injections to help the baby’s lungs mature, reducing the risk of breathing complications or death. Once the baby is born, care is tailored to their specific needs based on their age, weight and complications. Common challenges for preterm babies include breathing difficulties, heart complications, jaundice, inability to regulate body temperature and infections.
Managing these complications involves using warmers and incubators to maintain body temperature and
Kangaroo mother care where skin-to-skin contact helps stabilise the baby.
Breast milk is also recommended since it is vital for nutrition, weight gain, and infection protection.
Regular screening for hearing and vision issues is essential. Early exposure to oxygen can sometimes lead to a treatable form of blindness. Developmental milestones are also closely monitored after discharge.
Paediatricians often recommend social isolation to minimise exposure to infections and strict hygiene, to reduce the risk of illness.
