Newborn Health Kiwoko, Luwero District, Uganda

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Newborn HealthKiwoko, Luwero District, Uganda

• EPI/HSERV 544 Maternal/Child Health in
  Developing Countries
  
• January 24rd, 2008
• Maneesh Batra, MD MPH

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Setting - Uganda

• Population 27 million
• 84 rural
• Languages English, Luganda, Swahili
• Literacy Rate
• 69 (male), 59 (female)
• Per capita GNP 270
• Fertility rate 7.1 (5th in world)
• Malnourished Children 26
• Life expectancy 42 years

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Setting - Uganda

• Per Capita Govt healthcare spending 5
• NMR 29/1000 live births
• Annual Neonatal Deaths 40,900
• IMR 88.3/1000 live births
• U5MR 137/1000 live births
• MMR 435/100,000 live births
• Annual Maternal Deaths 6,100
• Stillbirths 31/1000 deliveries

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Setting - Uganda
21 of childhood deaths are newborns
Opportunities for Africas Newborns, 2006
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Setting Luwero District

• Area 5773.53 sq. km
• Population 492,184 (proj. 2000)
• 91.1 rural
• Population within 5 km of a health services unit
  53.
  
• Doctors to Population Ratio
• 123,438
• 16 doctors in the district
• IMR 112/100,000 live births
• U5MR 150/1000 live births

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Setting Luwero District

• Immunization Coverage 46
• Stunting Rate 36
• Acute Malnutrition 7
• Antenatal Care
• ANC attendance rate 75
• Delivery by trained staff 36
• Access to Safe Water 42
• Latrine Coverage 54

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Kiwoko Hospital

• Early 1990s - Abandoned school into a health
  clinic by Dr. Ian Clarke
  
• One of 3 hospitals in the district
• 4 full time doctors
• Serves population of 500,000
• Treats 25,000 people per year
• 1000 deliveries per year
• 1500 operations per year
• Most patients arrive by foot or bicycle

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Kiwoko Hospital
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Kiwoko Hospital

• 150-250 beds
• 8 wards (Peds, Malnutrition, Male, Female,
  Surgical, TB, Maternity, NICU)
  
• Outreach/Education

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Kiwoko Hospital - Resources

• Majority of care by family members
• Sporadic electricity
• Rain well water
• Limited vaccine supply
• BCG, DTP, Td, Measles, OPV
• Limited laboratory
• Limited medication supply
• Limited blood supply

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Kiwoko Hospital - NICU

• Built by ISIS, opened in 1999

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Kiwoko Hospital - NICU

• Primary Diagnoses
• LBW, Sepsis, Tetanus, Malaria, Meningitis,
  Asphyxia, Meconium Aspiration, Respiratory
  Distress
  

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Kiwoko Hospital - NICU

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

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Why do babies die in Luwero?

• At Home
• Largely unknown magnitude and scope of problem
• Barriers to seeking care
• Knowledge
• Impact on family unit
• What if the baby dies?
• Critical point of intervention!

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Why do babies die in Luwero?

• In the Hospital
• In-born
• LBW
• Sepsis
• Asphyxia
• Out-born
• Delayed presentation
• LBW
• Sepsis, Meningitis, Skin infections
• Tetanus
• ? Etiology
• Majority present with non-specific signs

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Improving Newborn Outcomes

• Framework
• Antenatal
• Antenatal care
• Immunization
• Malaria treatment
• Maternal nutrition
• Birth spacing

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Improving Newborn Outcomes

• Framework
• Peripartum
• Skilled birth attendant
• Immediate newborn care
• Obstetric emergencies

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Improving Newborn Outcomes

• Framework
• Postpartum
• Recognition of illness
• Appropriate initial stabilization and referral
• Nutritional management of LBW
• NICU care

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Thanks!