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45,000 babies die as officials think, fail to act

By Vision Reporter

Added 5th October 2008 03:00 AM

UGANDA has great thinkers according to the Unicef Representative in Uganda Keith McKenzie and Dr Emmanuel Otaala, the state minister for primary health care.
This was proved on September 30, at Imperial Royale, Kampala, when think tanks at the health ministry released a report on newborn babies.

UGANDA has great thinkers according to the Unicef Representative in Uganda Keith McKenzie and Dr Emmanuel Otaala, the state minister for primary health care.
This was proved on September 30, at Imperial Royale, Kampala, when think tanks at the health ministry released a report on newborn babies.

By Joseph Kariuki

UGANDA has great thinkers according to the Unicef Representative in Uganda Keith McKenzie and Dr Emmanuel Otaala, the state minister for primary health care.
This was proved on September 30, at Imperial Royale, Kampala, when think tanks at the health ministry released a report on newborn babies.

However, both McKenzie and Otaala are worried that the report Situational analysis of newborn health in Uganda: Current status and opportunities to improve care and survival may just gather dust on the ministry shelves.

But Otaala, wants it to be implemented to the letter because 200,000 children under five die annually, the report states. Of these, more than half die during their first year and 45,000 within the first month of birth.

What irked McKenzie is all the 45,000 children die of preventable diseases. “This is unacceptable and morally wrong…,” charged McKenzie.

According to World Health Organisation, only five babies per 1,000 live births die in developed countries and 42 babies in least developed countries. The Director, Health Services Dr Nathan Kenya-Mugisha said: “We need to redirect our resources to more urgent needs, newborns should be our main focus.”

The report stated three major causes of newborn deaths. They are birth asphyxia (inadequate intake of oxygen by the baby during birth), infections, and complications of preterm birth.

These deaths occur in the early neonatal period and often result from obstructed labour or haemorrhage, which are linked to the delay in mothers accessing health care.

“A woman with obstructed care has a 7 to 85 times higher risk of her baby dying compared to a normal birth,” said Dr. Gelasius Mukasa.

Explaining birth asphyxia, Dr. Mukasa said up to 10% of children require assistance to initiate breathing at birth. “Data shows over 26% of neonatal deaths are due to birth asphyxia,” she added.

McKenzie said all deaths from birth asphyxia can be prevented by use of proper equipment like resuscitation kits. Yet, ccording to the report, basic equipment and essential drugs for new-born care are lacking in many hospitals.

Infection at birth is another robber of newborn babies. Sepsis (a condition in which the body is fighting a severe infection that has spread via the bloodstream), pneumonia, meningitis, tetanus and diarrhoea are single most killers of newborns.

Dr. Jessica Jitta says: “Infections can be prevented through two doses of the tetanus toxoid vaccine during antenatal care with hygiene practices during childbirth, clean cord care after birth and exclusive breastfeeding,” says Dr. Jitta.

The report points a finger at some cultural practices as one recipe for infections. One such practice is the application of ash by traditional birth attendants, which increases newborn deaths.

Early treatment of infections through routine care is extremely important, the report adds. The third cause of newborn deaths is preterm birth, which is responsible for 25% of them.

In addition more than half of the babies are born at home and mothers do not take their babies to be weighed. During the study, only 61% reported their babies to have been weighed soon after birth.

“Even babies born in health facilities may not be weighed due to lack of equipment or broken scales,” says the report. “Sometimes health workers do not have the skills for weighing newborns.”

Although there is no data about birth weight in Uganda, but where available 10 to20 % had low birth weight states the report. Small babies have increased risk of death said Dr. Jitta.

According to the Uganda Demographic Health Survey 2006, the mortality rate of children reported as small was twice higher (45 per 1,000 live births) than those who were average or large at birth (21 per 1,000 live births).

Newborns and their mothers are inseparably linked. The death of a mother increases the risk of newborn death, says the report. This means although maternal mortality is reducing with the latest figures at 435, Dr. Pius Okong says there is no reduction in newborn deaths.

The report puts maternal mortality at 435 to 550 deaths per 100,000 live births resulting in around 8,000 maternal deaths in Uganda annually.

This figure shows that contrary to the belief that maternal mortality is reducing, this findings show that the figure has gone up slightly from 6,000 to 8,000.

“The reduction in maternal mortality is so small that it will not have a significant reduction on newborn deaths, the reduction is largely in other areas like HIV,” said Dr. Okong.

Globally, Sub-Saharan Africa has the highest total fertility rate. Uganda has the fifth highest total fertility rate in Africa at an average of 6.6 births per woman says the report. This results to shorter birth intervals, and greater risk of newborn death.

Poverty and poor access to healthcare could be the fundamental cause of all the newborn deaths in Uganda says Otaala.
“Many deaths that occur in the first month are a result of poverty.

Most at risks babies are born to young mothers, babies born to rural areas and slums who cannot afford healthcare,” said Otaala.

The minister notes that services are not available in the health centres: “we have no strategy to support newborn in their first week despite Uganda having good policies on maternal health.”

But Uganda is not alone in this fight. Medlineplus.org, a US government online resource centre, says a woman giving birth in sub-Saharan Africa is 100 times more likely to die in labour than a woman in a wealthy nation.

There are many challenges that face the newborns which need to be addressed. There are issues of lack of spousal support and information which we all need to address.

But we pray that this report will not gather dust at the ministry safes. We need to roll our sleeves and go to work.

45,000 babies die as officials think, fail to act

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