August 12th, 2022
When Sister Christine Otai joined the Kiwoko Hospital in central Uganda in 1989 there were few newborn baby units anywhere in the country. There were no incubators. And with no means of keeping the premature babies warm, Sister Christine and other nurses would put the newborns next to their mothers. “The situation would have been similar across Uganda,’’ Sister Christine says. “Many mothers were losing their babies. And at Kiwoko, we couldn’t do much…’’
And then in 2000, the Adara Group supported the hospital to open a neonatal intensive care unit (NICU). Now, the Kiwoko NICU has about 1,300 admissions a year and newborn survival rates have gone from 61 per cent to 88 per cent. Since 2010, maternal deaths as a proportion of hospital births have fallen by 50 per cent. The Ugandan Ministry of Health has recognised the unit as a Centre of Excellence, and it has been named as an Exemplar in Global Health. In a practical sense, many women and their babies will come to the unit because of its reputation for quality care.
“Based on this success and knowing there are many lives being needlessly lost across Uganda each year, we have developed a model to share what has been done at Kiwoko, that can be used to help other facilities, and other countries, save newborn lives,’’ Sister Christine says.
It’s called AdaraNewborn and it will take the Kiwoko model and introduce it across 10 health facilities across Uganda across the next decade with the broader goal of supporting the nation to meet the United Nations Sustainable Development Goals for maternal and newborn mortality.
It will be a challenge. At the moment, Uganda will not meet the SDG goal of 12 deaths per 1000 births by 2030 and instead is forecast to reach 21.9 deaths for every 1000 births. AdaraNewborn seeks to impact that by providing support across pregnancy, birth and then returning home.
“Women are provided with the care they need before, during and after birth: newborns have access to high-quality interventions through dedicated newborn units,’’ Sister Christine says. “Parents receive support when taking their newborns home and families and communities thrive.’’
The key parts in this evidence-based model have been increasing access to vaccinations, and educating parents on recognising danger signs, nutrition, sanitation and how newborns develop. Lactation and breastfeeding support have meant that 99 per cent of mothers and
babies are breastfeeding, with a similar average increased weight gain on being sent home.
The model’s roll out will be built around two regional hubs of newborn care that will each feature a Centre of Excellence or Regional Referral Hospital that will in turn work with target health facilities at different levels of the health system.
The Nakaseke Hospital became the most recent AdaraNewborn site in 2018 and introducing, then upgrading the neonatal unit has already made a difference to local newborn survival rates. Local and global partners are essential to the program’s evolution, and the Ugandan Ministry of Health, the Ugandan National Newborn Steering Committee, the Murdoch Children’s Research Institute and the World Health Organisation are among the diverse range of partners engaged in supporting AdaraNewborn.
Integral to the approach is supporting nursing staff, who come to feel that they are part of an inspiring and holistic approach to caring for new mothers and babies. Sister Christine, who became Adara’s National Newborn Trainer in 2017, knows the importance of recruiting, training and mentoring nurses and midwives in Uganda.
“I’ve seen how guidance, encouragement and support can provide a mentee with a broad range of personal and professional benefits, which ultimately led to improve performance in the workplace,’’ she says. “When nurses are inspired to be champions of newborn health, they drive continued, sustainable change.’’
AdaraNewborn provides a training program, quality improvement systems and strengthening of governance to support nursing and midwifery.
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