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Strengthening health facilities for maternal and newborn care: experiences from rural eastern Uganda.

Namazzi G, Waiswa P, Nakakeeto M, Nakibuuka VK, Namutamba S, Najjemba M, Namusaabi R, Tagoola A, Nakate G, Ajeani J, Peterson S, Byaruhanga RN - Glob Health Action (2015)

Bottom Line: The mean post-training knowledge score was 68% compared to 32% in the pre-training test, and 80% 1 year later.There was a non-significant declining trend for in-hospital neonatal deaths across the 2-year study period.Health system strengthening for care at birth and the newborn period is possible even in low-resource settings and can be associated with improved utilisation and outcomes.

View Article: PubMed Central - PubMed

Affiliation: School of Public Health, College of Health Science, Makerere University, Kampala, Uganda.

ABSTRACT

Background: In Uganda maternal and neonatal mortality remains high due to a number of factors, including poor quality of care at health facilities.

Objective: This paper describes the experience of building capacity for maternal and newborn care at a district hospital and lower-level health facilities in eastern Uganda within the existing system parameters and a robust community outreach programme.

Design: This health system strengthening study, part of the Uganda Newborn Study (UNEST), aimed to increase frontline health worker capacity through district-led training, support supervision, and mentoring at one district hospital and 19 lower-level facilities. A once-off supply of essential medicines and equipment was provided to address immediate critical gaps. Health workers were empowered to requisition subsequent supplies through use of district resources. Minimal infrastructure adjustments were provided. Quantitative data collection was done within routine process monitoring and qualitative data were collected during support supervision visits. We use the World Health Organization Health System Building Blocks to describe the process of district-led health facility strengthening.

Results: Seventy two per cent of eligible health workers were trained. The mean post-training knowledge score was 68% compared to 32% in the pre-training test, and 80% 1 year later. Health worker skills and competencies in care of high-risk babies improved following support supervision and mentoring. Health facility deliveries increased from 3,151 to 4,115 (a 30% increase) in 2 years. Of 547 preterm babies admitted to the newly introduced kangaroo mother care (KMC) unit, 85% were discharged alive to continue KMC at home. There was a non-significant declining trend for in-hospital neonatal deaths across the 2-year study period. While equipment levels remained high after initial improvement efforts, maintaining supply of even the most basic medications was a challenge, with less than 40% of health facilities reporting no stock-outs.

Conclusion: Health system strengthening for care at birth and the newborn period is possible even in low-resource settings and can be associated with improved utilisation and outcomes. Through a participatory process with wide engagement, training, and improvements to support supervision and logistics, health workers were able to change behaviours and practices for maternal and newborn care. Local solutions are needed to ensure sustainability of medical commodities.

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Health facility deliveries from Iganga/Mayuge Demographic Surveillance Site.
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Figure 0001: Health facility deliveries from Iganga/Mayuge Demographic Surveillance Site.

Mentions: During the implementation period, there was an increase in the number of deliveries conducted at health facilities within the study period, from 3,151 at the beginning of the intervention in the second half of 2009, to about 4,115 deliveries (an increase of 30%) at the end of the study (Fig. 1). Despite this increase, there was no change in the proportion of births resulting in caesarean section, which was 12% at the beginning of implementation in 2009 and 13% by the end of implementation. The rate of preterm birth was 8% in deliveries occurring in health units. The number of sick neonates from the community admitted to the neonatal unit also increased. A total of 249 sick newborn babies were admitted to the paediatric neonatal unit during the study period. The in-hospital neonatal mortality rate amongst admitted sick neonates declined from 17% in the first quarter to 9% in the last quarter, although the trend was non-significant.


Strengthening health facilities for maternal and newborn care: experiences from rural eastern Uganda.

Namazzi G, Waiswa P, Nakakeeto M, Nakibuuka VK, Namutamba S, Najjemba M, Namusaabi R, Tagoola A, Nakate G, Ajeani J, Peterson S, Byaruhanga RN - Glob Health Action (2015)

Health facility deliveries from Iganga/Mayuge Demographic Surveillance Site.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4385205&req=5

Figure 0001: Health facility deliveries from Iganga/Mayuge Demographic Surveillance Site.
Mentions: During the implementation period, there was an increase in the number of deliveries conducted at health facilities within the study period, from 3,151 at the beginning of the intervention in the second half of 2009, to about 4,115 deliveries (an increase of 30%) at the end of the study (Fig. 1). Despite this increase, there was no change in the proportion of births resulting in caesarean section, which was 12% at the beginning of implementation in 2009 and 13% by the end of implementation. The rate of preterm birth was 8% in deliveries occurring in health units. The number of sick neonates from the community admitted to the neonatal unit also increased. A total of 249 sick newborn babies were admitted to the paediatric neonatal unit during the study period. The in-hospital neonatal mortality rate amongst admitted sick neonates declined from 17% in the first quarter to 9% in the last quarter, although the trend was non-significant.

Bottom Line: The mean post-training knowledge score was 68% compared to 32% in the pre-training test, and 80% 1 year later.There was a non-significant declining trend for in-hospital neonatal deaths across the 2-year study period.Health system strengthening for care at birth and the newborn period is possible even in low-resource settings and can be associated with improved utilisation and outcomes.

View Article: PubMed Central - PubMed

Affiliation: School of Public Health, College of Health Science, Makerere University, Kampala, Uganda.

ABSTRACT

Background: In Uganda maternal and neonatal mortality remains high due to a number of factors, including poor quality of care at health facilities.

Objective: This paper describes the experience of building capacity for maternal and newborn care at a district hospital and lower-level health facilities in eastern Uganda within the existing system parameters and a robust community outreach programme.

Design: This health system strengthening study, part of the Uganda Newborn Study (UNEST), aimed to increase frontline health worker capacity through district-led training, support supervision, and mentoring at one district hospital and 19 lower-level facilities. A once-off supply of essential medicines and equipment was provided to address immediate critical gaps. Health workers were empowered to requisition subsequent supplies through use of district resources. Minimal infrastructure adjustments were provided. Quantitative data collection was done within routine process monitoring and qualitative data were collected during support supervision visits. We use the World Health Organization Health System Building Blocks to describe the process of district-led health facility strengthening.

Results: Seventy two per cent of eligible health workers were trained. The mean post-training knowledge score was 68% compared to 32% in the pre-training test, and 80% 1 year later. Health worker skills and competencies in care of high-risk babies improved following support supervision and mentoring. Health facility deliveries increased from 3,151 to 4,115 (a 30% increase) in 2 years. Of 547 preterm babies admitted to the newly introduced kangaroo mother care (KMC) unit, 85% were discharged alive to continue KMC at home. There was a non-significant declining trend for in-hospital neonatal deaths across the 2-year study period. While equipment levels remained high after initial improvement efforts, maintaining supply of even the most basic medications was a challenge, with less than 40% of health facilities reporting no stock-outs.

Conclusion: Health system strengthening for care at birth and the newborn period is possible even in low-resource settings and can be associated with improved utilisation and outcomes. Through a participatory process with wide engagement, training, and improvements to support supervision and logistics, health workers were able to change behaviours and practices for maternal and newborn care. Local solutions are needed to ensure sustainability of medical commodities.

Show MeSH