Understanding newborn care in Uganda: Towards future interventions
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Worldwide, almost four million babies die every year in the first month of life and another three millions are born dead. The highest rates are in Africa. In Uganda, over forty thousand newborn deaths and a similar number of stillbirths occur per year. Unless substantial reduction in these deaths occurs, the Millennium Development Goal four- to reduce child mortality by two thirds by 2015 will not be achieved. The World Health Organisation identified sixteen key practices and interventions such as providing delivery in a health facility, newborn resuscitation, warm care at birth, exclusive breastfeeding, and hygienic umbilical cord care that if properly used by all parents could reduce by 72%, but these are currently not reaching most newborn babies in Africa. In the thesis I investigated why newborn babies die and which care seeking delays (at home, on the way to care, and in health facilities) lead to newborn deaths, and the acceptability at community level of the evidence-based newborn care practices that are recommended by the World Health Organisation. I found that whereas most globally recommended newborn care practices were acceptable to the local community in Uganda, a few such as delayed bathing and dry cord care, were not, and need local adaptation prior to implementation. In addition, I found that care practices for newborn babies were of poor quality, and most babies died because of delays at home related to inability of household members to recognise sick newborns or deciding to seek for care from a health facility. In addition, health workers lacked skills in newborn care, and health facilities were poorly organised and did not have the basic equipment, drugs and supplies needed for the care of newborn babies. Based on the findings, I recommend prioritising newborn health, and that implementation of evidence-based newborn interventions promoted by the World Health Organisation needs adaptation to the local context. In addition, health facilities need strengthening in terms of management, health worker skills, equipment, drugs and supplies. Finally, due to inadequacy of qualified health workers, programmes should consider integrating lay people or community health workers to promote proper maternal/newborn care especially in hard-to-reach areas. The PhD is part of a special joint PhD programme between Makerere University and Karolinska Institutet in Sweden. Based on the results, funding has been acquired for a large scale trial that is underway in eastern Uganda as a learning project to improve newborn health at a low cost.