Uganda's health facilities struggle to care for preterm babies

Health facilities across the country are struggling to offer care to premature babies, this publication has established.
A mini-survey conducted by the Daily Monitor countrywide established that some facilities lack equipment and adequate personnel to take care of such babies, while others are overwhelmed by huge numbers of pre-matures either born at the facilities or referred.

Officials in Ngora, for example, disclosed that the district health facility lacks such a unit despite increasing cases of babies born before the due date.
Dr Julius Onyait, the district health officer (DHO), said the only neonatal unit offering such services is run by Ngora Freda Carr, a hospital that was built by the Anglican Missionaries in 1920s and is currently run by Kumi Anglican Diocese “We don’t have a centre for managing premature babies,” he said, adding: “All cases that need neonatal services have to be referred to Ngora Freda Carr where there are radiant warmers.”
In Katakwi District, the situation is equally grave. Dr Simon Icumar Omeke, the DHO, said until last month, the district hospital had one radiant warmer at its neonatal unit but has since been bailed out by Stanbic Bank, which donated a second warmer to the facility.

In Mbarara, Dr Deus Twesigye, the Mbarara Regional Referral Hospital director, said their Neonatal Intensive Care Unit (NICU), has witnessed a substantial increase in preterm admissions, with 45 percent of the 5,000
annual paediatric ward admissions being premature babies. This, he said, has forced babies to share facilities.
“The unit was designed to accommodate 10 babies. Often these babies share beds where we accommodate around 40 per day,” he said.
Dr Twesigye said currently, they have 11 phototherapy machines instead of 25 and three warmers out of the required 10.

Efforts
“To address this challenge, the government has already embarked on the construction of a modern 100-bed NICU, the first of its kind in East Africa, valued at $1.9 million (Shs7b). This facility will not only enhance neonatal care services but also serve as a training hub for pediatric specialists,” he said.
“Additionally, the government has constructed a 100m³/hr oxygen plant and installed piped oxygen in all wards, including the NICU, reducing reliance on oxygen cylinders and ensuring timely access,” he added.
Dr Alfred Yayi, the director of Jinja Regional Referral Hospital, said the facility has only 12 incubators out of the 30 needed.
Dr Yayi said on average, about 60 premature babies are born at the hospital every month, rendering the few incubators around not enough. He, however, said mothers, whose babies are not in critical condition, have been encouraged to opt for the kangaroo method, where they wrap babies on their chests to offer warmth.

“Handling premature babies is very delicate and referring them is very risky, so we appeal to the ministry for more than 30 incubators to rescue and give better services,’ ’Dr Yayi said. 
Dr Ismail Wangubo, the officer in-charge of Mayuge Hospital, said the incubators they have are not enough to handle the high number of babies admitted to the facility.
“We have only four incubators at the neonatal unit, yet we receive many premature babies and those in need of oxygen. We refer some of them to Jinja Regional Referral hospital ,’’ he said.

Dr Wangubo said they need about 10 incubators to handle the big number of patients.
He added: “The space is inadequate to accommodate a large number of incubators. Although we need more, we don’t have a place where to put them.’’
Dr Aggrey Bameka, the acting Jinja District health officer, said Buwenge General Hospital has seven functional incubators out of the 10 needed in the neonatal unit.
“Sometimes we get more than seven babies requiring incubation so we end up placing two babies in one incubator, which is not healthy,” Dr Bameka said.
At Nakaseke General Hospital, authorities said the NICU has eight incubators, seven warmers and six phototherapy machines that complement the management process of the premature babies admitted. Ms Teddy Asaba, the officer-in-charge of the NICU, said the facility still needs more accessories and medicines to serve better.

At Kiwoko Hospital, a private facility under the Church of Uganda, Luweero Diocese, the NICU has a bed capacity of 38 beds and a more spacious NICU, providing care to an estimated 1,200 newly born babies.
The facility has 11 incubators, 15 baby warmers and phototherapy machines.
While Kiwoko Hospital admits more premature babies, the district health department says the facility is still overwhelmed by the numbers that fail to match the NICU routine admission numbers daily.

At Luweero Hospital, the NICU facility has an admission capacity of eight babies. Dr Brono Oyik, the hospital medical superintendent, said the NICU needs more equipment and staffing to help in the effective delivery of healthcare.

Mr Richard Bantubalamu, the Kalisizo Hospital administrator in Kyotera District, said the facility sometimes gets an overwhelming number of premature babies yet they can only accommodate two babies.
“The facility has only two incubators and when they are filled up, we refer others to Masaka Regional Referral Hospital,” he noted.

Dr Frank Kisakye, a medical officer at Kalangala Health Centre IV, said the neonatal space at the main health facility in the island district is small, prompting them to refer others to distant facilities. 
“We have one incubator, but it’s not enough,” he noted.
Masaka Regional Referral Hospital has three automated incubators, compared to the 10 it needs. According to the head of the section, Dr Gerald Ojambo, the facility receives at least 30 patients daily who require incubators.
 

Sharing incubators

“During times when the facility receives high numbers, we are prompted to make the babies share the incubators available so that they can all be catered for,” he said.

At Arua Regional Referral Hospital, there is congestion because the NICU was constructed to accommodate only 16 babies. At the ward, it is common to see two babies sharing the same bed because of the inadequate bedding and incubators.

The principal nursing officer, Sr Suzan Tabu, said on average, they handle about 150 babies monthly. This, she said, has strained the few health workers.
“We have only 12 incubators and five ordinary beds, which are inadequate to accommodate all the premature babies,” she said.

In Moyo, Mr Christopher Waswa, the officer-in-charge of the NICU at Moyo Hospital, said the facility was established in 2020 by Unicef.
“Currently, we have an average of 70 babies per month. And so, this causes congestion because the unit was meant for a few babies. We have several equipment, which includes incubators, warmers and others,”Mr Waswa said.
Mr Bernard Besi, the Moyo General Hospital Senior Administrator, said the management of the babies at the facility is good.

“But our biggest challenge is the limited space for NICU. We have some equipment that cannot even fit in the current space. If we had resources, we would be able to expand it,”he said. The director of Yumbe Regional Referral Hospital, Dr Patrick Odong, said the NICU’s capacity is 20 beds but at certain moments, there is overcrowding.

Dr Rhoda Mayiga, the head of the Paediatrics Department at Mengo Hospital, said they currently have nine incubators but plans are underway to increase this number to at least 45.
Dr Julius Luyimbazi, the executive director of Lubaga Hospital, revealed that the NICU at the facility has a capacity of 12 incubators and some warmers.

Dr Luyimbazi said the ideal number would be 30, and that the hospital needs support to get there. Dr Evelyn Nabunya, the executive director of Mulago Specialised Women and Neonatal Hospital, said premature babies make up half of all admissions in the neonatal unit.
Dr Henry Mwebesa, the director general of Health Services at the Ministry of Health, while officiating at the launch of a Shs1 billion breast milk bank project at Mulago on November 13, said managing premature babies is a delicate and costly process.
“Running a Neonatal Intensive Care Unit is very expensive. We require a lot of human resources, equipment running 24 hours and supplies including oxygen. Our unit at Mulago Specialised Hospital charges about Shs1m per week compared to some private hospitals that charge between Shs3m and Shs6m per week,” Dr Mwebesa said.
“We feel Shs1m is not too much, though some mothers in my village cannot afford it, but we need to see how to support the hospital to run,” he added.
He said the government facilities need funds to support neonatal units to remain operational and avoid becoming what he termed ghost units.
Dr Mwebesa cited pre-eclampsia, infections, malaria, and anaemia as some triggers of pre-mature births. He encouraged expectant women to attend antenatal care, and go for preventive treatment for malaria to ensure their safety and that of their babies.

Compiled by Jane Nafula, Simon Peter Emwamu, Felix Ainebyoona, Al-Mahdi Ssenkabirwa, Dan Wandera, Richard Kyanjo, David Ssekayinga, Malik Fahd Jjingo, Denis Edema, Abubaker Kirunda,
Tausi Nakato, Felix Warom Okello, Scovin Iceta and Robert Edema.