Newborn mortality hopes still hanging by a thread

Health experts have warned that the government’s complacency in addressing the skills gap among health workers, lack of equipment in facilities and poor supervision has impeded the fight to reduce infant deaths in the country.

The country is registering up to 30 infant deaths per 1,000 births, a number several times higher than four deaths per 1,000 births registered in developed countries like in Europe, according to a 2022 World Population Data Sheet released in September by Population Reference Bureau (PRB), a global research organisation.

Uganda, according to government statistics, already missed the Millennium Development Goal of reducing the infant mortality rate by 66 percent from 107 deaths per 1,000 births in 1990 to 36 deaths per 1,000 births in 2015.

In 2015, the Uganda Bureau of Statistics (Ubos) conducted a national survey and found that the infant mortality rate was at 43 deaths per 1,000 births due to the above gaps.

Dr Olive Sentumbwe, the World Health Organisation (WHO) family, health and population advisor, warned that Uganda is making very slow progress towards the Sustainable Development Goal of cutting newborn deaths by 50 percent by 2030. Currently, the newborn deaths (within 28 days of life) stand at 27 per 1,000 births, according to the Health ministry.

“There is slow progress in all the areas we need to work on,” she revealed, adding, “On neonatal mortality, the greatest contributors are asphyxia and preterm deaths. Of course, we also have other contributors like neonatal sepsis.”

Neonatal mortality refers to the death of a child within 28 days of life, while perinatal death refers to the death of a child during delivery or within seven days of life. Asphyxia, on the other hand, refers to the failure of the baby to start breathing after birth, usually resulting from labour and birth complications.

Absenteeism

When we visited Orum Health Centre IV on September 19, the biggest public facility in Otuke District that serves a 100,000-strong population, there was no clinician to attend to patients in the outpatient department.

Otuke has one of the highest infant mortality rates in the country, standing at 53 deaths per 1,000 births, according to Ubos.

Around 90 percent of people in the outpatient department were young children and we witnessed children convulsing and becoming unconscious because there were no doctors to attend to them.

“I came here at 7am. My son started convulsing in the night, and we brought him to the hospital here very early in the morning but there is no doctor up to now [12.30pm]. I have no money, I could have gone somewhere else,” Josephine Akello said.

Around 150 patients were still waiting, but others who could afford to pay for care in small private clinics in the town had already left Orum Health Centre IV. The district also grapples with high poverty rates and poor roads.

The head of the facility, Dr James Olum, was not around and neither did he pick up our repeated calls. One of the interns, who preferred to speak on condition of anonymity because of protocol issues, said:  “About 80 percent of these children have malaria, but there is no one to prescribe medicine. The clinician, who was supposed to be on duty, didn’t report. We are still waiting. We can’t proceed without him. There used to be around two clinicians. We don’t have the records person also.”

Dr Robert Oremo, the Otuke District health officer, told this newspaper that he couldn’t comment on the issue of delays in accessing services because he was not in the office. But Mr Francis Abola, the district chairperson, said they are struggling to address delays in accessing health services in the facility.

“Many health workers of Orum Health Centre IV sleep in Lira [city], so they travel back on Mondays [after spending weekends with their families in Lira],” he said.

Poor infrastructure

While Lira is about 100kms away from Otuke, the access road is in a poor state. The hospital, located near the town of Otuke, one of the least developed parts of the Lango Sub-region, also lacks adequate accommodation for staff and even patients were squeezed into small spaces to access care because of small buildings.

We found them screening for non-communicable diseases like high blood pressure and obesity under a tree because there was no facility for the clinic. Non-communicable diseases account for around 33 percent of deaths in the country every year.

Otuke is hardly the exception. At Masaka Regional Referral Hospital, the mothers who had come for antenatal care spent hours before accessing care.

“I brought my wife at 7:30am and I don’t know when I will leave. People are too many at the antenatal clinic. But there is no way out,” Peter Ahabwe said.

Mr Ahabwe also had a sick child, aged around three, who needed medical care.

“He can’t eat anything because of some oral disease. But they have to finish with the mother before I can take him to the outpatient department,” he said.

Dr Charles Olaro, the director of clinical services, while commenting on the situation of child health in Uganda, said: “We need to cascade the interventions [that have worked] to all parts of the country and we also need to be accountable for our action.”

The other common cause of death among newborns is preterm birth, which is also partly a result of complications from the mother such as untreated malaria, according to studies in the country. “We need to sustain mothers who will give us better quality of babies,” Dr Sentumbwe advised.

The expert said over 50 percent of service providers are not adhering to what they are supposed to be doing, adding that “one in 10 patients are harmed while receiving care in our hospitals.”

“Forty percent of our facilities lack running water and 30 percent lack sanitation facilities and this also affects the interest of our mothers in going to the facilities. Women also experience abuses at health facilities,” she further noted.

Ms Margaret Muhanga, the minister of State for Primary Health Care, said the issues raised are being addressed.

“We need to sensitise mothers on what they should do when they are pregnant and also as they get close to giving birth. You know many mothers don’t go for antenatal care and that brings complications when they are giving birth, but if they are monitored through this time, it is easier to monitor any of the arising risks,” she said.

Obstructed labour

Dr Olive Sentumbwe, the World Health Organisation (WHO) family, health and population advisor, was particularly worried by obstructed labour that is often the product of “the long distance, delays at home and hospital.”

“The failure of the baby to breathe after birth causes death. The young babies who are born are dying before they are 28 days, the number is still high. The latest survey shows 27 per 1,000 live births are dying. Our target is 12 per 1,000 [by 2030],” Dr Richard Mugahi, the assistant commissioner for reproductive and infant health at the Health ministry, said, adding that 12 deaths per 1,000 live births “is still very high when compared to what is happening in developed countries.”

He said the ministry is establishing newborn care units in all public facilities to ensure children survive.

“We are putting them up at health centre IIIs, IVs and hospitals. We are trying to put facilities like oxygen in those health facilities to save babies with breathing difficulties,” he revealed, adding, “Right now, all health centre IVs and hospitals have oxygen.”

It, however, appears not all health facilities have some of these units functional as some broke down. This is worsened by the lack of supervision.