UNICEF provides special spaces for small babies to survive and grow safely

Saving small and sick babies

By Proscovia Nakibuuka Mbonye
newborn health, new born health
UNICEF Uganda/2019/Abdul
02 January 2020

A huge signpost signaling visitors to wash their hands hangs at the entrance of the neonatal intensive care unit in Arua Regional Referral Hospital. The reason for the handwashing practice is to control and prevent infections that can kill small and sick newborn babies admitted in the unit. The babies are very vulnerable and require specialized care in this special space. No one can bring in street shoes – they too carry germs.

In the clean and warm unit, preterm babies and other ill babies with various conditions like birth injuries, fever, infection, severe birth asphyxia, breathing problems, congenital abnormalities and hypothermia lie in different rooms, some in incubators, others under the photo therapy machine and some under the warmer. All the equipment, incubators, examination beds, Kangaroo Mother Care (KMC) wraps and much more in the unit were provided by UNICEF with financial assistance from the Swedish International Development Cooperation Agency (SIDA). 

The material support was preceded by health worker training by UNICEF ESARO on caring for small and sick babies and Kangaroo Mother Care (KMC). 

“With the equipment and no knowledge, we did not achieve much. But now, with knowledge and equipment, our practice has changed. We have greatly reduced the number of deaths occurring among babies born preterm and other small babies through KMC and other sick newborns are also able to receive the care that they need,” 

says Sister Ngamita Jane Opio, Assistant Nursing Officer in the unit.

Sister Ngamita was among those that started the unit and can testify that currently the small babies admitted in the unit are much safer than before the establishment of the unit in 2015. She further shares that the need for the unit arose after many preterm babies and small and sick babies died in the maternity wing and others at home after they were discharged. 

The unit was started with only one wooden incubator and a few beds that were shared by several babies. Today, an average of 140 babies are admitted a month, the majority of whom recover and are discharged.

newborn health, new born health
UNICEF Uganda/2019/Abdul

In the corridor, Janet Tuakwaje, a 26-year-old South Sudan refugee mother carries her small baby on her bare chest to keep him warm as she tries to breastfeed him. Exclusive breastfeeding is one of the practices promoted in the unit. This is done while the baby also gets warmth from the mother’s chest. Beyond the warmth, this skin-to-skin contact promotes milk production and growth of the baby through stimulation of the brain. In addition, mothers are also taught about hygiene, nutrition and how to identify danger signs in the baby.
 
Due to prolonged labor, Janet’s baby was in distress, which resulted in birth asphyxia and a high temperature. She has spent three days in the unit, while the baby receives treatment. “He is much better than when we were admitted, and my breastmilk is beginning to come.” She was worried but after treatment and care, she is optimistic that her baby will improve, and that they will be discharged.

newborn health, new born health
UNICEF Uganda/2019/Abdul

In another room, several small babies lie in incubators. They are being fed through tubes by the health workers who confirm that they are gaining weight. The babies are fed a little breast milk at a time as they are too small to suckle a breast. They all weighed below one kilogram at birth because they were born too early. One has stabilized and can breathe on his own. 

newborn health, new born health
UNICEF Uganda/2019/Abdul

In another room lies 28-year-old Joyce Amaniyo with her baby girl tied on her chest. Her baby came early, at six months, weighing only 0.9 kilos. Joyce has spent two weeks at the unit. This was her first experience of giving birth to a preterm baby. When she saw how tiny her baby was right after delivery, she immediately lost hope and wanted to abandon her. “She didn’t not look like my other babies. She was very weak and small, and I thought she was going to die.” With counselling and treatment, Amaniyo has been able to accept her baby. She learnt how to apply Kangaroo Mother Care for warmth and is exclusively breastfeeding the little one. She also received peer-to-peer support from fellow mothers in the unit.

In Uganda, newborn conditions contribute 42 per cent of under-five deaths (UDHS 2016), killing about 31 babies every day. UNICEF is supporting health facilities with health worker training, equipment and newborn care units to provide quality care for small and sick babies. 

Confident with the right knowledge and the right equipment, the health workers in the unit can properly care for these very vulnerable babies. They constantly monitor any major complications that the admitted babies may have, and work with other units at the hospital like maternity to address gaps in care. An example was the sharp increase in sepsis among babies admitted in October 2019. The issue was addressed with the maternity unit and the numbers of sick babies significantly reduced in the following months. 

Competent in ensuring the survival of the little ones, the health workers in the unit are training other midwives at lower levels of the public healthcare system in Kangaroo Mother Care and how to care for small and sick babies. To date, 62 midwives have been trained, and Kangaroo Mother Care has been rolled out in all 16 health centres IVs in West Nile Region, thanks to UNICEF and SIDA.