Doctors with Africa Cuamm Mothers and Children First: the first steps - Uganda Info: www.doctorswhithafrica.org
Uganda, Oyam District
Yumbe Maracha
Kotido
Arua
Moroto
Nyapea
Nebbi Angal
1,000 live births (total of 39,000 deaths per year). • Stillbirth is 25 per 1,000 live births (38,000 deaths per year).
Matany
Oyam District
Naggalama Kampala
Nyenga Nkokonjero
Nkozi
National health statistics • 24.5% of the population lives below the poverty threshold that corresponds to 1.25 USD per day. • Maternal mortality rate is 438 deaths every 100,000 live births (5,000 maternal deaths per year). • The under five mortality rate is 68 per 1,000 live births (103,000 deaths per year) • Neonatal mortality is 26 per
National health policies and data • Ratio of health personnel is 14.3 per 10,000 inhabitants. • The per capita health expenditure is 118 USD (in PPP). • The National Health Plan gives priority to the primary healthcare services and includes a programme on safe motherhood. • The decentralisation process is on-going and includes the strengthening of maternal health units. • A programme at national level is being implemented that reduces the duration of the training period and allows for a bigger number of midwives to be trained.
n. 1 surgeon and n. 1 paediatrician. • At district level the following services have been guaranteed: free transport and management of obstetric emergencies, supply of equipment, drugs and capacity building of local human resources.
Intervention in the District of Oyam and Aber Hospital • Population: 378,900 inhabitants (approx. 18,000 expected deliveries). • Health facilities: n. 6 peripheral maternal units and one hospital belonging to the diocese of Lira (200 beds). • Number of midwives: 37. • Expatriate personnel of Doctors with Africa Cuamm:
Tools: World Bank 2009 Uganda Demographic Health Survey 2011 World Health Statistics 2012
Activities in 2012 (first year of implementation) N. of skilled attened deliveries (over the expected in the District)
7,753 (42%)
N. of attended deliveries at Aber Hospital
2,151
N. of caesarean sections
445
Proportion of caesarean sections and number of expected births (5-15% standard) N. of ambulance emergency transports
172
N. of health personnel trained on obstetric and neonatal emergency
1.5%
Proportion of maternal deaths for indirect causes at hospital level
33%
Available service Unavailable service
1 Parenteral administration of antibiotics
–
Services 1 - 7 Basic essential obstetric and neonatal care / BEmOC Basic Emergency
–
Services 1 - 9 Comprehensive essential obstetric and neonatal care / CEmOC
Aber Hospital Health Centre 1 Health Centre 2 2 Parenteral administration of oxytocin
Health Centre 4 Health Centre 5 Health Centre 6
Oyam District, Uganda
9 Cesarean section
3 Removal of retained products of conception
4 Manual removal of placenta
8 Blood transfusion
7 Assisted vaginal delivery with vacuum or forceps
5 Newborn resuscitation with mask and ambubag 6 Parenteral administration of anticonvulsants
92
Direct obstetric case fatality rate (standard <1)
Figure 1. Essential obstetric and neonatal emergency care 1
Health Centre 3
2.4%
1
Tool used: Need assessment of emergency and neonatal care, Columbia University, AMDD 2011.
Doctors with Africa Cuamm Mothers and Children First: the first steps - Uganda Info: www.doctorswhithafrica.org
Figure 2. Quality of mother and neonatal healthcare services 2
1.25
1
Availability of equipment and consumables
Infrastructure
0 - 0.9 Sustantial improvements are needed in order to avoid serious threats to mothers and newborn health.
1 Laboratory diagnostics availability
2
1.4
Availability of drugs
Statistics
1.25
0.6
Maternal unit
Nursery Unit
2-3 Improvements are needed in order to minimize potential threats to health of mothers and newborns while respecting their dignity and rights.
1.3
1.4 Access to hospital healthcare
Normal labour
Aber Hospital Uganda
0.9 Guidelines and auditing procedures
1 - 1.9 Improvements are necessary in order to avoid risks for women and newborn.
1.6 Cesarean Sections
1.6
1.57
Monitoring and follow up
Management of maternal complications
1.52 Management of emergencies
1.9
–
0.9 Sick newborn care
P
Infection control and supportive care
1.3 2
Tool used: Assessment tool for the quality of hospital care for mothers, newborn and child, WHO 2009.
Routine neonatal care
Figure 3. Socio-economic profile of women delivering at hospital level and health centres at district level 3
– 77% of women Health centre t
100%
Hospital
77
80%
–
– 77% of women that give birth at Aber Hospital belong to the wealthiest quintile none of them to the poorest quintiles. – 40% of women that give birth in Health Centres belong to the wealthiest quintile and only 6% to poorest quintiles.
60%
43 40 40%
20 20% 8
8
2
2
0% Quintile 5
Quintile 4
Quintile 3
Quintile 2
wealthiest
Quintile 1
poorest
3
Tool used: Proxy Wealth Index, Demographic Health Survey Uganda 2006.