14 December 2012

Uganda: Coping With a Pre-Term Birth

In Kenya, as across Africa, the death rate of newborn babies is tragically high. But at Kenyatta General Hospital, here in the capital city of ... ( Resource: Kangaroo Care in Kenya

Mulago Hospital's Special Care Unit is a beehive of activity. As some mothers express breast milk to feed their little ones in the incubators, others are seated on a bench with their babies strapped onto their chests.

Kangaroo mother care is a practice of strapping a baby onto a mother's chest, skin-to-skin, to ensure physiological and psychological warmth and bonding.

According to Dr. Jamir Mugalu, the of the head special care unit at Mulago Hospital, four to six pre-term babies are received daily at the special care unit general ward on the fifth floor and about three to four pre-term at the private ward on the sixth floor.

This translates into about 124 to 184 pre-term babies a month.

A pre-term/premature baby is one born before 37 weeks.

Premature birth complications:

Dr. Catherine Tumwesigye, a paediatrician at the Newborn Unit, Nsambya Hospital, says according to 2012 data compiled at the unit, pre-term births are the leading cause of admissions, constituting about 23%. "Pre-term birth complications are the leading cause of death in newborns and they constitute 37% at the hospital."

Records at the health ministry indicate that about 209,700 pre-term babies were born last year. "Every year about 16,000 newborns in Uganda (40%) die as a result of pre-term birth complications."

Dr. Gelasius Mukasa, the chairman of the National Newborn Steering Committee, adds that in Uganda, pre-term births are the leading cause of death in children under five years and in the critical first month of life.

Why the increase?

Dr. Charles Kiggundu, a gynaecologist and obstetrician at Mulago Hospital, says there are more pre-term babies today because of the increase in the number of women giving birth and the growing population.

Kiggundu further attributes this to the increase in teenage pregnancies and the number of career women, who have babies after the age of 40.

Mugalu says ignorance and inaccessibility to regular antenatal care have contributed to the rise in pre-term births. This is because complications may arise, resulting in pre-term labour.

Dr. Margret Nakaketo, a senior paediatrician, adds that the increase in pre-term births is because more mothers are delivering in health facilities, making it possible for medical workers to care for them.

Prevention strategies:

Dr. Hanifah Ssengendo of Save the Children, an NGO, says pre-term births can be prevented through interventions like attending antenatal care at least four times during pregnancy, ensuring you are attended to by a skilled birth attendant and spacing childbirth to enable the mother's body to recover fully. "A pregnant woman should also guard against malaria and avoid drug abuse and alcohol."

Dr. Jessica Nsungwa, the assistant commissioner for child health at the health ministry, says the first 24 hours of care are critical in saving a pre-term baby. If one misses the initial intervention, complications may arise, she warns.

Ssengendo advises mothers to practise basic life-saving interventions like keeping the baby warm, observing hygiene, especially when cleaning the umbilical cord and breastfeeding exclusively.

"A mother experiencing pre-term labour can also be given dexamethsone to stimulate the baby's lungs and prevent breathing problems at birth," Ssengendo says. The drug is free in government health facilities and costs about sh2,500 in private facilities.

Nakaketo encourages mothers of preterm babies to practice the kangaroo method. A preterm baby has to be kept warm because the tiny body loses heat rapidly, making the child highly vulnerable to illnesses.

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