Ugandan children survive by chance at birth. As such, a child is more likely to be born preterm, or too early, in Uganda more than in any other country in the east African region and is less likely to survive here.
“All newborns are vulnerable, but preterm babies are acutely so,” says UN Secretary General Ban Ki-moon, who considers the effort to reduce preterm births and deaths an integral part of his Global Strategy for Women’s and Children’s Health.
According to a report launched this week, ‘Born to Soon: The Global Action Report on Preterm Birth’ for every 100 births, 13.6 percent of these are likely to be born preterm in Uganda compared to 12.3 percent in Kenya and less than 11. 6 percent in Tanzania, Rwanda and Burundi.
Preterm is defined as 37 weeks of completed gestation or less, according to the World Health Organisation (WHO) definition. The full term period for carrying a baby to birth is 39 weeks.
Preterm births account for almost half of all newborn deaths worldwide and are now the second leading cause of death in children under 5, after pneumonia according to the WHO.
In Uganda, 44,500 babies die within 28 days of birth annually. Studies show that 31 percent die of pneumonia, 26 and 25 percent of breathing problems and preterm respectively. Why?
Peter Waiswa, a researcher at the School of Public Health, Makerere University College of Health Sciences says the problem is two fold. A general weakness of the health system and inequity of interventions, which are not reaching the most at risk populations.
Waiswa says Ugandan women unlike their counterparts in the east African region have a higher fertility rate -6.7 percent-, which means more pregnancies that are also spaced too closely together, a contributing factor for having preterm babies. They also use contraceptives less.
A study on ‘Uganda Newborn Survival’ by the Makerere University College of Health Services points out that women, the primary players in preterm births; lack birth preparedness, skilled care at delivery, no care for sick newborns and pregnant women do not attend antenatal clinics.
Continuous surveillance for the preterm babies is also almost non-existent as many mothers deliver from home. Although with no research backup, Ugandan women are said to have more multi-fetal pregnancies- twins, triplets and higher, a risk factor for preterm.
However, the preterm babies, who die could survive without expensive care if a few proven and inexpensive treatments and preventions were available worldwide, according to the ‘Born to Soon’ report.
“People tend to associate preterm with high-cost intensive care services which would be challenging to poor countries, but a whole menu of effective, inexpensive services are available and work to save most of these lives,” says Carole Presern, PhD, a midwife who has delivered babies in remote areas of Asia and is the Director of The Partnership for Maternal, Newborn & Child Health.
Spotlighting preterm births may help many low-income countries, mainly in sub-Saharan Africa, achieve UN Millennium Development Goal 4, a two-thirds reduction in young child deaths, and Goal 5, improved maternal health, by 2015. These goals were set by the United Nations General Assembly in 2000.
Dr. Hanifah Naamala Sengendo the program manager, Saving Newborn Lives at Save the Children, says timely, evidence-based low cost and high impact interventions are known. The only problem is implementing them.
For instance Kangaroo Mother Care, where the infant is held skin-to-skin on the mother’s chest to keep warm which makes frequent breastfeeding easy, increases bonding and provides constant maternal supervision for the infant.
“We know this intervention can work very well but our priorities as a country are different. Even mothers, when they deliver preterm babies they want incubators, hot water bottles because they are not aware,” said Dr. Sengendo who emphasized more education of these interventions to empower women and create behavior change.
Providing low-cost interventions such as preventing and treating infections, encouraging immediate and exclusive breast-feeding and keeping newborns warm and dry could also prevent preterm deaths.
Save the Children Uganda is now implementing a Newborn and Child Survival Campaign called ‘every one’ a part of the worldwide campaign to mobilize global action to reduce the number of preventable deaths to children under age 5. The campaign aims to ensure that the most vulnerable children will be reached.