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Uganda Newborn Study (UNEST): learning from a decade of research in Uganda to accelerate change for newborns especially in Africa.

Lawn JE, Kerber K, Sankoh O, Claeson M - Glob Health Action (2015)

View Article: PubMed Central - PubMed

Affiliation: MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK.

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Investment in a healthy birth gives a triple return as this is the moment of greatest risk for women, stillbirths, and newborns and also crucial for child development and human capital... Yet despite great potential for mortality reduction, progress remains slow, with neonatal mortality reducing at about half the speed of maternal mortality or child mortality after the first month... With funding from The Bill & Melinda Gates Foundation through Save the Children's Saving Newborn Lives programme, researchers in Uganda partnered with national policymakers and district leaders to conduct UNEST as a two-arm cluster randomised trial evaluating a package of home visits during pregnancy and the postnatal period, with improved facility-based care effecting both the intervention and control arms... This worker was recruited by their own community in line with national policy (developed alongside UNEST as described by Waiswa et al. and trained to identify pregnant women and make five home visits: two before and three in the first week after birth... : The UNEST results demonstrate that home visits were possible to achieve with relatively high coverage (over 40% on the first day after birth and almost two-thirds visited in the first week), and that home behaviours could be changed by this interaction... Immediate and exclusive breastfeeding were significantly higher in the intervention arm compared to control (72.6% vs. 66.0%; p<0.016 and 81.8% vs. 75.9%; p<0.042, respectively)... Half (49.6%) the mothers in the intervention arm delayed bathing their baby by more than 24 hours, compared to 35.5% in the control arm (p<0.001)... Dry umbilical cord care was significantly higher in intervention areas (63.9% vs. 53.1%; p<0.001)... Importantly, in contrast to the marked inequity around facility-based care at birth and for illness, these home visits were pro-poor, with more women in the poorest quintile, who are most at risk, visited by a CHW compared to families in the least poor quintile... Improving the quality of facility-based care around the time of birth is especially critical to reducing maternal deaths and stillbirths, but this should be done with concurrent interventions to address demand-side barriers... In UNEST, Kiguli et al. and Nalwadda et al. sought to understand the sociocultural context around the time of birth and the reasons for not seeking care promptly, in order to design and implement interventions effectively... Uganda has gone further than many countries with a national newborn steering committee, standard for care at all levels and an increasing voice from parliamentarians, but there remains a policy-practice gap... Let us learn from this evidence, and add more as we move faster for our smallest and most vulnerable citizens.

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Ian Hurley/Save the Children, Uganda.
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Related In: Results  -  Collection

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Figure 0001: Ian Hurley/Save the Children, Uganda.


Uganda Newborn Study (UNEST): learning from a decade of research in Uganda to accelerate change for newborns especially in Africa.

Lawn JE, Kerber K, Sankoh O, Claeson M - Glob Health Action (2015)

Ian Hurley/Save the Children, Uganda.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4385209&req=5

Figure 0001: Ian Hurley/Save the Children, Uganda.

View Article: PubMed Central - PubMed

Affiliation: MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Investment in a healthy birth gives a triple return as this is the moment of greatest risk for women, stillbirths, and newborns and also crucial for child development and human capital... Yet despite great potential for mortality reduction, progress remains slow, with neonatal mortality reducing at about half the speed of maternal mortality or child mortality after the first month... With funding from The Bill & Melinda Gates Foundation through Save the Children's Saving Newborn Lives programme, researchers in Uganda partnered with national policymakers and district leaders to conduct UNEST as a two-arm cluster randomised trial evaluating a package of home visits during pregnancy and the postnatal period, with improved facility-based care effecting both the intervention and control arms... This worker was recruited by their own community in line with national policy (developed alongside UNEST as described by Waiswa et al. and trained to identify pregnant women and make five home visits: two before and three in the first week after birth... : The UNEST results demonstrate that home visits were possible to achieve with relatively high coverage (over 40% on the first day after birth and almost two-thirds visited in the first week), and that home behaviours could be changed by this interaction... Immediate and exclusive breastfeeding were significantly higher in the intervention arm compared to control (72.6% vs. 66.0%; p<0.016 and 81.8% vs. 75.9%; p<0.042, respectively)... Half (49.6%) the mothers in the intervention arm delayed bathing their baby by more than 24 hours, compared to 35.5% in the control arm (p<0.001)... Dry umbilical cord care was significantly higher in intervention areas (63.9% vs. 53.1%; p<0.001)... Importantly, in contrast to the marked inequity around facility-based care at birth and for illness, these home visits were pro-poor, with more women in the poorest quintile, who are most at risk, visited by a CHW compared to families in the least poor quintile... Improving the quality of facility-based care around the time of birth is especially critical to reducing maternal deaths and stillbirths, but this should be done with concurrent interventions to address demand-side barriers... In UNEST, Kiguli et al. and Nalwadda et al. sought to understand the sociocultural context around the time of birth and the reasons for not seeking care promptly, in order to design and implement interventions effectively... Uganda has gone further than many countries with a national newborn steering committee, standard for care at all levels and an increasing voice from parliamentarians, but there remains a policy-practice gap... Let us learn from this evidence, and add more as we move faster for our smallest and most vulnerable citizens.

No MeSH data available.