The Overview
In Uganda, very few women, newborn and children have access to essential, quality, affordable and effective services they need, not only to survive but to thrive. As result, hundreds of thousands of women specifically pregnant and women of reproductive age group die every year from avoidable or treatable conditions, million infants die within their first weeks of life, and millions more children and adolescents suffer avoidable deaths from malnutrition, pneumonia, diarrhea, or vaccine-preventable diseases. PICSA Uganda with the support of donors and partners, support and work alongside the government to reduce maternal and newborn deaths, ensure women can access the tools they need to safely plan their families, scale up cervical cancer screening and treatment, and protect against childhood illness, disease, and chronic malnutrition.
Challenges
Although there has been progress over the past two decades, a pregnant woman or newborn still dies somewhere in Uganda every 11 seconds. Most of these deaths occurs in low income and underserved communities reflecting inequalities accessing quality health services. The odds of survival for women and infants living in poorer rural communities are far worse. If they experience complications during birth, they are less likely to make it to a health facility in time. Nearly half of all under-five deaths occur during the first 28 days of life. Simple quality, affordable and effective interventions can prevent unintended pregnancies, treat pregnancy and labor complications, and save the lives of newborns.
The challenge is to implement them in a reliable and timely way. Working with district health services around the districts in Uganda, PICSA Uganda has developed an integrated approach to address these challenges to serving women throughout their reproductive years, enabling them to safely avoid or plan pregnancies, have a healthy pregnancy and delivery, and ensure their newborns can thrive.
Approach
Saving Lives At Birth Reducing Maternal And Newborn Mortality
PICSA Uganda partnered with the government to reduce the maternal and newborn mortality in high level district wide Covering 1 million people women and newborn leveraging saving lives at birth model to avert preventable maternal and newborn death.
Modified Integrated Management of Childhood Illnesses (IMCI)
PICSA Uganda partnered with the Ministry of Health to avert death of newborn and under five children in all the health facilities and communities. PICSA Uganda supported in undertaking a high impact intervention across the health facilities and the communities within the districts. Efforts focused on bringing high quality newborn and under five children services nearer closer to the community and supporting health workers and community volunteers to provide quality maternal and newborn care.
The re-introduction of the modified IMNCI influenced the district heath team priority at district, health facility and community level with plans to mobilize and scale the key live saving interventions to all health facilities. We supported the training of health workers at the health facilities to provide quality services through the use of modified IMNCI. The training of the health workers contributed to bringing newborn and child health services closer to the population they serve.
The health workers were trained on 1) Assess the young infant or child 2 months to five years (taking history and physical examination), 2) Classify the illness based on severity of the condition, 3) Identify appropriate treatment for the classified illness using the chart, 4) Treat the young infant or child with prescribed drugs or other home remedies, 5) Management of sick young infant from birth up to 2 months, 6) Counsel the mother on feeding, foods and fluids to be given and when to bring back the young infant or child to the clinic, 7) Mothers counseling card.
Impact To Date
Labour guide and paper based partograph at health facilities
PICSA continued to support maternal and newborn program that aim to reduce mother and neonatal mortality and institutional still birth across the health facilities and the communities. PICSA Uganda revitalized the use of paper based partograph commonly referred to as Labour guide to enhance and reinforce monitoring of labour the health facilities by birth attendant. PICSA Uganda with Madiro Fund supported the training and enhancement of the capacity of midwives on using the revised Ministry of Health and World Health Organization (WHO) labour guide.
PICSA Uganda helped to ensure the use of the guide and paper based partograph for monitoring of women in labour for real time reporting of labour progress, complication and pathways for referral in case of complication that requires further medical management at higher level.
We also encouraged the review of the outcome of labour and deaths at the health facilities by the health workers
The training and enhancement of labour guide, the use of partograph for monitoring labour by the health workers has improved on the detection of complications and immediate response and referral, thereby reducing maternal deaths.
90 percent of the mothers were monitored using paper based partograph. Connection between the lower health facilities and the referral hospital for alerting the team for further action in the hospital setting during complication is has improved slightly and this support is needed in the next phase of the project. PICSA Uganda effort in enhancing the capacity of the health workers has resulted into improvement in the proportion of deliveries monitored and documented using either the paper or e-Partograph. substantially monitored.
Impact To Date
Post Partum Hemorrhage Management
PICSA Uganda is at the forefront of providing technical support to the local government to optimize postpartum hemorrhage prevention and management by improving access to high quality care, ensuring appropriate PPH management in line with updated World Health Organization (WHO) guidelines.
PICSA Uganda is supporting the local government in training health workers on prevention and management of PPH and other life-threatening maternal conditions. Our training has enhanced the capacity of Health workers on various aspect of PPH such as knowing definition of PPH, types, causes, investigation, diagnosis, and emergency management with placenta in or out, subsequent treatment and follow-up. We improve effective management of third stage of labour and how to identify and handled emergencies.
We ensure health workers had their capacity enhanced on bleeding after birth (postpartum hemorrhage), hypertension in pregnancy, bleeding in pregnancy; abortion before 26 weeks of gestation and its complications, antepartum Hemorrhage (placenta Previa and abruption placenta) after 26 weeks of gestation and before birth of the baby, ruptured uterus, malaria in pregnancy, anemia in pregnancy, shock, sepsis and difficult deliveries such as breech, shoulder dystocia, face and brow presentations, prolonged and obstructed labour, pre and postoperative complications.
Through PICSA Uganda effort, the district Health team printed and made available PPH management guideline. This was done to address the gap with the guidelines and management protocols which is considerable, the gold standard for PPH management.
Simple hypothermia prevention activities at the health facilities and communities
Newborn, can’t easily access facilities where they ca be kept warm in case of hypothermia leading to deaths. With Funding from Madiro and Child Health Foundation (CHF), PICSA Uganda implemented hypothermia prevention at the 26 health facilities in the district.
PICSA Uganda, using a train-the-trainers model, helped to train health workers at the peripheral health facilities. The train the trainers’ model aimed to improve the health worker as well the caretaker’s knowledge and skills on hypothermia prevention at health facilities and communities. Effort to train health worker on the low-cost hypothermia (Kangaroo Mother Care) was because, it is simple-cost-effective and sustainable skin to skin care) for prevention of hypothermia in newborns and reduce mortality from low temperature.
Health workers were trained on skin-to-skin contact, keeping warm, referral to hospital, giving oxygen and feeding of the preterm babies with expressed breast milk using the nasogastric tube or clean cup. With PICSA Uganda support, all the trained health workers are implementing the simple hypothermia prevention. The skin-to-skin method has been beneficial to the mothers and babies as it promotes warmth, bonding, attachment and early initiation of breastfeeding.
Impact To Date
Deployment of infant warmers to prevent hypothermia
Many patients experiencing hypothermia are overlooked because facilities do not have the correct equipment or tools or health workers have not been trained to see signs or understand symptoms of hypothermia Even when hypothermia is diagnosed, equipment may not be available and this is driven by the constraint in supply, lack of resources and human resources in addition to challenges in deploying and prioritizing resources.
As part of reducing newborn mortality from hypothermia, PICSA Uganda supported local government to train sixty health workers who were trained on simple hypothermia prevention techniques on infant warmers commonly referred to as INCU BLANKET.
PICSA Uganda also supported the procurement infant warmer for small and term babies were procured outside Uganda (VIA Global Health from USA). Expensive though, one can last for ten years. This PICSA Uganda visions as the best choice for underserved facilities with no power supply. The INCU BLANKET is deployed to the selected health facilities with high burden hypothermia.
Impact To Date
Increasing access to diagnosis and treatment for Hypoxemia in under-fives
Many patients experiencing hypoxemia are overlooked because facilities do not have the correct diagnostic tools or health workers have not been trained to see signs or understand symptoms. Even when hypoxemia is diagnosed, oxygen may not be available to treat patients Oxygen shortages are driven by constraints in supply, human resources, and funding, in addition to challenges in deploying resources rapidly and efficiently Strengthening oxygen systems, including ensuring every sick patient is screened for hypoxemia using pulse oximeters and all hypoxemic patients receive oxygen, can reduce mortality rates by as much as 50 percent.
PICSA Uganda prioritized supporting the local government of Moyo District to enable them to meet the demand for childhood pneumonia and other morbidity that required oxygen. PICSA Uganda in collaboration with the district health services developed a plan and improve the long-term access to diagnostic tools and other essential respiratory care equipment within broader health systems.
PICSA Uganda, between 2022 and 2023 with funding from Madiro and Child Health Foundation supported the district health Team in Moyo to procure ten (10) pulse oximeter for executing the oxygen needs of the newborn and the under-five children. Of the procured oximeters were placed in the hospital maternity and newborn intensive units, and the health center level four. The procurement and training of the health workers enabled rapid assessment of the respiratory needs of the newborn and the children
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