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Newborn Health Kiwoko, Luwero District, Uganda

Newborn Health Kiwoko, Luwero District, Uganda. EPI/HSERV 544 – Maternal/Child Health in Developing Countries January 23 rd , 2007 Maneesh Batra, MD MPH. Setting - Uganda. Population - 2.3 million, 84% rural Languages - English, Luganda, Swahili Literacy Rate – 69%male, 59%female

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Newborn Health Kiwoko, Luwero District, Uganda

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  1. Newborn HealthKiwoko, Luwero District, Uganda EPI/HSERV 544 – Maternal/Child Health in Developing Countries January 23rd, 2007 Maneesh Batra, MD MPH

  2. Setting - Uganda • Population - 2.3 million, 84% rural • Languages - English, Luganda, Swahili • Literacy Rate – 69%male, 59%female • Per capita GNP - $310 • Fertility rate – 7.1 (5th in world) • NMR – 33.1/1000 live births • IMR – 88.3/1000 live births • U5MR – 151.5/1000 live births • MMR – 880/100,000 live births • Malnourished Children - 26% • Life expectancy - 42 years

  3. Setting – Luwero District

  4. Setting – Luwero District • Area: 5773.53 sq. km • Population: 492,184 (proj. 2000) • 91.1% rural • 8.1% urban • Pop. Growth Rate: 2.3 % per yr. • Avg. size household: 5 • Population within 5 km of a health services unit: 53%. • Doctors to Population Ratio • 1:23,438 • 16 doctors in the district

  5. Setting – Luwero District • Immunization Coverage: 46% • IMR: 112/100,000 live births • U5MR: 150/1000 live births • Stunting Rate: 36% • Acute Malnutrition: 7% • Antenatal Care • ANC attendance rate: 75 % • Delivery by trained staff: 36 % • Access to Safe Water: 42% • Latrine Coverage: 54%

  6. Kiwoko Hospital • Early 1990s - Abandoned school turned into a health clinic by Dr. Ian Clarke • One of 3 hospitals in the district • 4 full time doctors • Serves population of 500,000 • Treats 25,000 people per year • 1000 deliveries per year • 1500 operations per year • Most patients arrive by foot or bicycle

  7. Kiwoko Hospital

  8. Kiwoko Hospital • 150-250 beds • 8 wards (Peds, Malnutrition, Male, Female, Surgical, TB, Maternity, NICU) • Outreach/Education

  9. Kiwoko Hospital - Resources • Majority of care by family members • Sporadic electricity • Rain + well water • Limited vaccine supply • BCG, DTP, Td, Measles, OPV • Limited laboratory • Limited medication supply • Limited blood supply

  10. Kiwoko Hospital - NICU Built by ISIS, opened in 1999

  11. Kiwoko Hospital - NICU Primary Diagnoses: • LBW, Sepsis, Tetanus, Malaria, Meningitis, Asphyxia, Meconium Aspiration, Respiratory Distress

  12. Kiwoko Hospital - NICU • 20 beds, 3 functioning incubators • ½ of admissions inborn • Overall Mortality 20-30% • Tetanus Mortality 80-90%

  13. Why do babies die in Luwero? At Home • Largely unknown magnitude and scope of problem • Barriers to seeking care • Knowledge • $$$$$$$$$ • Impact on family unit • What if the baby dies?

  14. Why do babies die in Luwero? In the Hospital • In-born • LBW • Sepsis • Asphyxia • Out-born • Delayed presentation • LBW • Sepsis, Meningitis, Skin infections • Tetanus • ? Etiology • Majority present with non-specific signs

  15. Improving Newborn Outcomes Framework • Antenatal • Antenatal care • Immunization • Malaria treatment • Maternal nutrition • Birth spacing

  16. Improving Newborn Outcomes Framework • Peripartum • Skilled birth attendant • Immediate newborn care • Obstetric emergencies

  17. Improving Newborn Outcomes Framework • Postpartum • Recognition of illness • Appropriate initial stabilization and referral • Nutritional management of LBW • NICU care

  18. Thanks!

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