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Newborn HealthNewborn HealthKiwoko, Luwero District, Kiwoko, Luwero District,
UgandaUganda
EPI/HSERV 544 – Maternal/Child Health in EPI/HSERV 544 – Maternal/Child Health in Developing CountriesDeveloping Countries
January 23January 23rdrd, 2007, 2007Maneesh Batra, MD MPHManeesh Batra, MD MPH
Setting - UgandaSetting - Uganda
Population - 2.3 million, 84% ruralPopulation - 2.3 million, 84% rural Languages - English, Luganda, Languages - English, Luganda,
SwahiliSwahili Literacy Rate – 69%male, 59%femaleLiteracy Rate – 69%male, 59%female Per capita GNP - $310Per capita GNP - $310 Fertility rate – 7.1 (5Fertility rate – 7.1 (5thth in world) in world) NMR – 33.1/1000 live birthsNMR – 33.1/1000 live births IMR – 88.3/1000 live birthsIMR – 88.3/1000 live births U5MR – 151.5/1000 live birthsU5MR – 151.5/1000 live births MMR – 880/100,000 live birthsMMR – 880/100,000 live births Malnourished Children - 26%Malnourished Children - 26% Life expectancy - 42 yearsLife expectancy - 42 years
Setting – Luwero Setting – Luwero DistrictDistrict
Setting – Luwero Setting – Luwero DistrictDistrict
Area: 5773.53 sq. kmArea: 5773.53 sq. km Population: 492,184 (proj. Population: 492,184 (proj.
2000)2000) 91.1% rural91.1% rural 8.1% urban 8.1% urban
Pop. Growth Rate: 2.3 % Pop. Growth Rate: 2.3 % per yr.per yr.
Avg. size household: 5Avg. size household: 5 Population within 5 km of a Population within 5 km of a
health services unit: 53%.health services unit: 53%. Doctors to Population RatioDoctors to Population Ratio
1:23,438 1:23,438 16 doctors in the district16 doctors in the district
Setting – Luwero Setting – Luwero DistrictDistrict
Immunization Coverage: Immunization Coverage: 46%46%
IMR: 112/100,000 live IMR: 112/100,000 live birthsbirths
U5MR: 150/1000 live birthsU5MR: 150/1000 live births Stunting Rate: 36%Stunting Rate: 36% Acute Malnutrition: 7%Acute Malnutrition: 7% Antenatal Care Antenatal Care
ANC attendance rate: 75 %ANC attendance rate: 75 % Delivery by trained staff: 36 %Delivery by trained staff: 36 %
Access to Safe Water: 42%Access to Safe Water: 42% Latrine Coverage: 54%Latrine Coverage: 54%
Kiwoko HospitalKiwoko Hospital Early 1990s - Abandoned Early 1990s - Abandoned
school turned into a health school turned into a health clinic by Dr. Ian Clarkeclinic by Dr. Ian Clarke
One of 3 hospitals in the One of 3 hospitals in the districtdistrict
4 full time doctors 4 full time doctors Serves population of Serves population of
500,000500,000 Treats 25,000 people per Treats 25,000 people per
yearyear 1000 deliveries per year1000 deliveries per year 1500 operations per year1500 operations per year Most patients arrive by Most patients arrive by
foot foot or bicycleor bicycle
Kiwoko HospitalKiwoko Hospital
Kiwoko HospitalKiwoko Hospital 150-250 beds150-250 beds 8 wards (Peds, Malnutrition, Male, Female, 8 wards (Peds, Malnutrition, Male, Female,
Surgical, TB, Maternity, NICU)Surgical, TB, Maternity, NICU) Outreach/EducationOutreach/Education
Kiwoko Hospital - Kiwoko Hospital - ResourcesResources
Majority of care by Majority of care by family membersfamily members
Sporadic electricitySporadic electricity Rain + well waterRain + well water Limited vaccine supplyLimited vaccine supply
BCG, DTP, Td, Measles, BCG, DTP, Td, Measles, OPVOPV
Limited laboratoryLimited laboratory Limited medication Limited medication
supplysupply Limited blood supplyLimited blood supply
Kiwoko Hospital - NICUKiwoko Hospital - NICU
Built by ISIS, opened in 1999Built by ISIS, opened in 1999
Kiwoko Hospital - NICUKiwoko Hospital - NICU
Primary Diagnoses: Primary Diagnoses: LBW, Sepsis, Tetanus, Malaria, Meningitis, LBW, Sepsis, Tetanus, Malaria, Meningitis,
Asphyxia, Meconium Aspiration, Respiratory Asphyxia, Meconium Aspiration, Respiratory DistressDistress
Kiwoko Hospital - NICUKiwoko Hospital - NICU
20 beds, 3 functioning incubators20 beds, 3 functioning incubators ½ of admissions inborn½ of admissions inborn Overall Mortality 20-30%Overall Mortality 20-30% Tetanus Mortality 80-90%Tetanus Mortality 80-90%
Why do babies die in Why do babies die in Luwero?Luwero?
At HomeAt Home
Largely unknown Largely unknown magnitude and scope magnitude and scope of problemof problem
Barriers to seeking Barriers to seeking carecare
KnowledgeKnowledge $$$$$$$$$$$$$$$$$$ Impact on family unitImpact on family unit What if the baby dies? What if the baby dies?
Why do babies die in Why do babies die in Luwero?Luwero?
In the HospitalIn the Hospital In-bornIn-born
LBWLBW SepsisSepsis AsphyxiaAsphyxia
Out-bornOut-born Delayed presentationDelayed presentation LBWLBW Sepsis, Meningitis, Skin Sepsis, Meningitis, Skin
infectionsinfections TetanusTetanus ? Etiology? Etiology
Majority present with non-Majority present with non-specific signsspecific signs
Improving Newborn Improving Newborn OutcomesOutcomes
FrameworkFramework
AntenatalAntenatal Antenatal careAntenatal care
ImmunizationImmunization Malaria Malaria
treatmenttreatment Maternal Maternal
nutritionnutrition Birth spacingBirth spacing
Improving Newborn Improving Newborn OutcomesOutcomes
FrameworkFramework PeripartumPeripartum
Skilled birth Skilled birth attendantattendant
Immediate newborn Immediate newborn carecare
Obstetric Obstetric emergenciesemergencies
Improving Newborn Improving Newborn OutcomesOutcomes
FrameworkFramework PostpartumPostpartum
Recognition of Recognition of illnessillness
Appropriate initial Appropriate initial stabilization and stabilization and referralreferral
Nutritional Nutritional management of management of LBWLBW
NICU careNICU care
Thanks!Thanks!