Quality of essential newborn care at China-Uganda Friendship Regional Referral Hospital Naguru, amidst the COVID-19 pandemic

Abstract

Introduction: Uganda is one of the countries that committed to reducing neonatal mortality to at worst 12 deaths per 1000 live births by 2030 and owing to this, a number of strategies are being implemented to increase the number of pregnant women delivering from health facilities as an intervention for reducing maternal and newborn deaths. This has led to an increase in the number of health facility deliveries in the country; also, an observed gradual reduction in the neonatal mortality, however, in the more recent WHO report, Uganda recorded newborn deaths at 20 deaths per 1000 live births in 2019; way above the global target of 12 deaths per 1000 live births by the year 2030. This is indicating that although access to and availability of Medicare are both necessary factors for the improvements in newborn health and survival, they alone are not sufficient. High quality essential newborn care should therefore be emphasized to increase the likelihood of a good neonatal outcome and ultimately reduce neonatal mortality. Study Objective: To assess the quality of newborn care at CUFH-Naguru amidst the covid-19 pandemic. Methods: This was a cross-sectional study done at China-Uganda friendship hospital, Naguru. An inventory of the availability and functionality of structural inputs was done in addition to direct observation of the process of care for each baby born at the hospital, basing on WHO standards for improving quality maternal and newborn care at health facilities. Secondary data was reviewed , and key informant interviews were also done to study the effect of Covid-19 pandemic and to describe how the hospital was responding to and coping with the effects of covid-19 pandemic. Results: The quality of care in terms of availability of structural inputs for provision of good quality newborn care at CUFH-Naguru was rated as good with a mean availability score of 80.8%, which is very impressive although some very important equipment were not functional. Out of the 371 babies born at CUFH-Naguru that were included in the analysis; only 4% received good quality care while majority (94%) received fair quality of care and the rest (2%) received poor quality of care. Postnatal care at this hospital was poor and so was the health care providers‘ adherence to hand washing practice. HCPs were knowledgeable about routine newborn care but there was a gap between what they knew and the actual care they provided to newborns. The covid-19 pandemic has had a negative effect on the lives of HCPs and consequently newborn care outcomes such as still births increased from 24.7 in 2019 to 34.2 deaths per 1000 births in 2020. . Conclusion and Recommendation: The actual care received by newborns at CUFH-Naguru is short of the evidence -based WHO-recommended ‗good‘ standards therefore Quality improvement teams need to be strengthened to monitor and ensure that good quality care is consistently provided to all mothers and their newborns so to improve their survival and consequently reduce newborn mortality.