Doctors with Africa CuammMothers and Children First: the first steps - Uganda

National health statistics• 24.5% of the populationlives below the povertythreshold that correspondsto 1.25 USD per day.

• Maternal mortality rate is438 deaths every 100,000live births (5,000 maternaldeaths per year).

• The under five mortalityrate is 68 per 1,000 livebirths (103,000 deaths peryear)

• Neonatal mortality is 26 per

1,000 live births (total of39,000 deaths per year).

• Stillbirth is 25 per 1,000 livebirths (38,000 deaths peryear).

National health policies and data• Ratio of health personnel is14.3 per 10,000 inhabitants.

• The per capita healthexpenditure is 118 USD (inPPP).

• The National Health Plangives priority to the primaryhealthcare services andincludes a programme onsafe motherhood.

• The decentralisationprocess is on-going andincludes the strengtheningof maternal health units.

• A programme at nationallevel is being implementedthat reduces the duration ofthe training period andallows for a bigger numberof midwives to be trained.

Intervention in the District ofOyam and Aber Hospital • Population: 378,900inhabitants (approx. 18,000expected deliveries).

• Health facilities: n. 6peripheral maternal unitsand one hospital belongingto the diocese of Lira (200beds).

• Number of midwives: 37.• Expatriate personnel ofDoctors with Africa Cuamm:

n. 1 surgeon and n. 1paediatrician.

• At district level the followingservices have beenguaranteed: free transportand management ofobstetric emergencies,supply of equipment, drugsand capacity building oflocal human resources.

Tools:World Bank 2009Uganda Demographic Health Survey 2011World Health Statistics 2012

Uganda, Oyam District

Kotido

Oyam District

Yumbe

MarachaArua

Nyapea

Naggalama

NyengaKampala

NebbiMoroto

MatanyAngal

NkokonjeroNkozi

OyamDistrict, Uganda

1Parenteral administration of antibiotics

5Newborn resuscitation with mask and ambubag

6Parenteral administration of anticonvulsants

7Assisted vaginal delivery with vacuum or forceps

8Blood transfusion

9Cesarean section

2Parenteral administration of oxytocin

4Manual removal of placenta

3Removal of retained products of conception

Aber Hospital

Health Centre 1

Health Centre 2

Health Centre 3

Health Centre 4

Health Centre 5

Health Centre 6

Available serviceUnavailable service

– Services 1 - 7Basic essential obstetric and neonatal care / BEmOC Basic Emergency

– Services 1 - 9Comprehensive essential obstetric and neonatal care /CEmOC

Figure 1. Essential obstetric and neonatal emergency care1

1 Tool used: Need assessmentof emergency and neonatalcare, Columbia University,AMDD 2011.

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)

2.4%

N. of ambulance emergency transports 172

N. of health personnel trained on obstetric and neonatal emergency 92

Direct obstetric case fatality rate(standard <1)

1.5%

Proportion of maternal deaths for indirect causes at hospital level 33%

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1.4Statistics

2Availability of drugs

1.25Availability of equipment and consumables

1Laboratory diagnostics availability

1Infrastructure

1.25Maternal unit

0.6Nursery Unit

1.3Normal labour

1.6Cesarean Sections

1.57Management of maternal complications

1.3Routine neonatal care

0.9Sick newborn care

1.52Management of emergencies1.9

1.6Monitoring and follow up

0.9Guidelines and auditing procedures

1.4Access to hospital healthcare Aber

Hospital Uganda

Infection control and supportive care

0 - 0.9 Sustantial improvements are needed in order to avoid serious threats to mothers and newborn health.

1 - 1.9Improvements are necessary in order to avoid risks for women and newborn.

2 - 3 Improvements are needed in order to minimize potential threats to health of mothers and newborns while respecting their dignity and rights.

2

8 8

2

43

20

77

40

– 77% of women t

–

Qu

inti

le 1

Qu

inti

le 2

Qu

inti

le 3

Qu

inti

le 4

Qu

inti

le 5

0%

20%

40%

60%

80%

100%

poorest wealthiest

–

Health centre

Hospital

– 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.

P

Doctors with Africa CuammMothers and Children First: the first steps - Uganda

Figure 2. Quality of mother and neonatal healthcare services2

Figure 3. Socio-economic profile of women delivering at hospital level and health centres at district level3

2 Tool used: Assessment tool forthe quality of hospital care formothers, newborn and child,WHO 2009.

3 Tool used: Proxy Wealth Index,Demographic Health Survey Uganda2006.

Info: www.doctorswhithafrica.org