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Northern Uganda: Deliveries and ante-natal care attendance at health centres shoot up

newborn and maternal health interventions for refugees
© UGDA/2018/Sibiloni
A health worker examines a pregnant woman during an antenatal visit.
By Catherine Ntabadde Makumbi,

Four years ago, mothers and children in West Nile sub region were unable to access basic and essential health services due to several factors. In addition, the maternal and child health indicators in the sub region were significantly below the national levels and targets

In 2014, UNICEF and the 8 district local governments(DLG) of West Nile conducted a study on maternal and perinatal deaths. This study revealed that mothers and children in the sub-region were unable to access basic and essential health services due to a number of factors.

From the findings, the district authorities identified areas that needed to be strengthened one them being deliveries at the health centre and improvement in attendance of the first ante-natal care among others.

In 2018 the situation is different that the district health authorities feel confident to share their results with pride.

“We have improved greatly because we are above the national target in most of the indicators. Our deliveries are at 80 per cent above the national target of 65 per cent,” reveals Patricia Okumu, Acting District Health Officer Nebbi.

Okumu attributes the improvement to the continuous trainings and mentorship offered to the health workers by UNICEF using SIDA funds. She adds that the capacity building has strengthened the competency of the health care workers and improved their supportive attitude towards the patients.

Okumu adds that the health workers were trained in Basic Emergency Obstetrics and Newborn Care, Helping Babies Breath plus, Integrated Management of Childhood Illnesses, community newborn care and interpersonal communication skills.

WHO recommends that pregnant women visit a health facility after 2 consecutive missed periods to confirm pregnancy. Early attendance of antenatal care services, before 13 weeks of pregnancy, which marks the end of the first part (trimester) of pregnancy also ensures that mothers receive critical health promotion and disease prevention services like HIV screening and vitamin supplementation.

In Nebbi district, ANC visits within the first trimester have improved from 43 per cent in 2014 to 51 per cent in 2017. Other important indicators like immunization (DPT3) have also significantly improved from 73 per cent to 83 per cent. So Okumu attribute some of these improvements to the trainings which have resulted in attractive quality services.

As result of this improvement, the Ministry of Health in 2017 awarded Nebbi as the best district local government in steering reproductive health and family planning services in the country.

The improvement is attributed to SIDA through UNICEF which is supporting the implementation of the Improving Maternal, Newborn and Child Health through Integrated Approaches project in West Nile.

Mary Goretti Amonditho, Nursing Officer Nyaravur Health Centre III in Nebbi district says hypothermia has been one of the major health problem in the area, adding that it is history now. “We were not caring much about keeping babies warm especially under the Kangaroo method. We were negligent. We would have 3 infant deaths every year resulting from this problem. But with the training acquired, this year we have not registered any infant death,” Amonditho further reveals.

Amonditho who is a beneficiary of the training says she was trained how to manage 3rd stage of labour, what to do when the baby is immediately delivered, how to massage the uterus and control bleeding. “Our goal is to help mothers survive and help babies breath,” she says.

At Nyaravur, the health centre would receive 4 mothers seeking their services but now the number sometimes pushes to 60.

Nebbi Referral Hospital has registered 502 births since January to March 2018, 557 antenatal care visits for the 1st tremister during the same period. Winfred Akumu, Principal Nursing Officer at the hospital also attributed the overwhelming number of deliveries and ANC visits to the trainings of the health workers.

The Assistant Health Officer Arua district Paul Bishop Drileba says facility based delivery in the district is at 56 per cent. “A good proportion of our mothers now come to health centres to give birth,” Drileba narrates.

Ocea Health Centre IV in Rhino Camp Refugee Settlement in Arua which serves both South Sudanese refugees and nationals has had 542 mothers give birth at the facility from July 2017-March 2018.

UNICEF interventions with support from SIDA are targeting 74 per cent of deliveries at health centres in the West Nile sub region.

Apart from strengthening deliveries, conducting trainings, other supported activities include supportive supervision and mentorship of health providers, procurement and distribution of essential MNCH commodities and medical equipment; strengthening the supply chain management at all levels using mTrac – a software to track the supply stock out and availability, improving health facilities infrastructure, including improvements in water, sanitation and hygiene facilities and services; infection control measures and innovative approaches to supporting lighting and electricity in labour rooms, support to establishment and functionality of a surge model for emergency response, strengthening referral system from communities to health facilities and between health facilities and supporting the implementation of the community care for mothers and new-borns and WASH interventions.

Joyce Yangi who is expecting her first child says she prefers to deliver at the health centre to avoid any complications, being a first-time mother. “The midwife told me to give birth from here (Ocea Health Centre). It is my first time so I don’t know how it will go. Delivering from home is risky so I will come here in a months’ time to deliver,” she says.

Evelyn Mono who has delivered all her five children at a health centre says the health workers provide 24-hour attention at the time of delivery. “They keep checking on you, monitoring the baby to check the health while in the womb. Even when pushing (normal delivery), they are here,” Mono says. She adds that her fear of delivering at home is death resulting from over bleeding.
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