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How to Bend the Curve on Newborn Mortality – Key Learnings from Uganda

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March 31, 2015

This is an exciting time for advances in newborn care. Today a special issue on Newborn Health in Global Health Action is being launched to share the experience of how to scale up a cost-effective package of newborn care that involves families, community health workers and health facilities. What this study shows is that it is both possible and feasible to improve life-saving practices during pregnancy, childbirth and in the first weeks after birth among families in poor rural communities.

We have known for a long time about what works in newborn health, but we have struggled with how to implement what we know effectively.

The results of this community randomized trial, the Uganda Newborn Study (UNEST), show that home visits in pregnancy and soon after delivery  resulted in improved breastfeeding practices, skin-to-skin care immediately after birth, delaying a baby’s first bath, and hygienic care of the baby’s umbilical cord among the poorest households with lowest access to care.

Joy Lawn, Director of the MARCH Centre at the London School of Hygiene, and her co-authors of the editorial to the special issue identify four key learnings from Uganda:

  1. Scalability depends on recognition of community care as a part of the health system with consistent funding and supervision. The home visit package was well received by the community with 100% retention of the volunteer village health workers during implementation. The package was also pro-poor, with more women from the poorest families, who are most at risk, visited during pregnancy and after delivery compared to wealthier families.

  2. Quality care at facilities is crucial for ending preventable deaths amongst mothers and their babies. The Uganda Newborn Study worked with both public and private sector facilities to improve care. More women are giving birth in health facilities yet persistent staff shortages and supply chain failures for essential drugs and equipment continue to place lives at risk.

  3. Innovations can address key challenges: novel solutions for how address the realities of operating in a low resource setting were tested. Innovative solutions included a foot length card that village health workers can use, in the absence of a scale, to identify and refer small babies to the health facility for extra care.

  4. Local leadership is key and requires intentional strategies. More local leaders are needed, to champion the cause of improving care at birth and ending these preventable deaths.

This was the first study of its kind to be led and carried out by local researchers in Uganda. In fact, national research capacity was developed with two Ugandans completing their PhDs by coursework and publication on the study. We commend such embedded capacity development, which produces national newborn research capacity in addition to study results. Also exciting is that the implementation model and counselling materials developed in the study have subsequently become national MOH policy in Uganda.

We need more program implementation studies of this kind that help us identify and remove the barriers to scale up of known maternal and newborn interventions among the communities that would benefit the most.

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