In Uganda, child mortality rates are improving, but progress is slower for deaths occurring in the first four weeks of life, or the newborn period, and for stillbirths. But recent evidence from local researchers show that a cost-effective package of care linking families, government-mandated village health teams (a form of community health workers), and health facilities can improve life-saving practices during pregnancy, childbirth and in the first weeks of life; and benefit poorest families the most. This new evidence was published today as a special issue of the peer-reviewed journal Global Health Action.
The nine-article special issue, titled Newborn Health in Uganda, details results of a community randomized trial, the Uganda Newborn Study (UNEST), which evaluated an integrated care package linking homes, clinics and hospitals and involving visits during pregnancy and the postnatal period at home by a designated member of the village health team. The study was carried out in rural eastern Uganda by Ugandan researchers using existing health system structures and in partnership with national policy-makers and district leaders.
The UNEST results demonstrate that these home visits in pregnancy and soon after delivery were possible to achieve, and that life-saving behaviors could be improved by this interaction. Breastfeeding practices, skin-to-skin care immediately after birth, delaying a baby's first bath, and hygienic care of the baby's umbilical cord stump were higher amongst the families receiving home visits compared to those that did not receive them. Importantly, these home visits were pro-poor, with more women in the poorest households, who are at most risk of encountering difficulties in access to care, receiving an early home visit after delivery when compared to the wealthiest families.
According to the editorial published as part of the special issue, UNEST was influenced by the previously published neonatal survival series in the Lancet which identified cost-effective interventions that could prevent the majority of deaths in the newborn period.
It was this series that initially prompted Ugandan officials to act, organizing the nation's first stakeholder meeting on newborn survival and setting up the National Newborn Steering Committee which has proactively served as the country's lead advisory group on newborn care since 2009. UNEST, designed to address important gaps for care around the time of birth at community and facility level, was adapted from similar trials conducted in South Asia, and carried out concurrently with five other country trials conducted through the Africa Newborn Network.
Prof. Joy Lawn Director of the MARCH Centre at the London School of Hygiene, was involved in the trial from the outset. In the editorial, she and her co-authors identify four key learnings from UNEST:
The study, supported by funding from The Bill & Melinda Gates Foundation through Save the Children's Saving Newborn Lives program and the Swedish International Development Agency, was the first of its kind to be led and carried out by local researchers in Uganda.
Professor Stefan Peterson, co-Principal Investigator of the study says, "We are especially happy to have graduated three Ugandan PhDs from this study who are experts in newborn health research. Capacity development should be part of all studies and that is how we will build national cadres of researchers."
Among those leading the study was Dr. Peter Waiswa, from Makerere University School of Public Health and senior lecturer at Karolinska Institutet in Sweden. Dr. Waiswa explains, "I grew up around this region and know how important community is. As a medical doctor working within the rural health system before becoming a researcher, I felt there was more we could do to understand and address the gaps between households and health facilities that are keeping women from accessing quality care for themselves and their newborns."
The journal's special issue can be found at: http://www.globalhealthaction.net/index.php/gha/article/view/27574Search
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