After nearly two decades of inaction, Uganda has made some small strides in improving the health of newborns. Uganda is not on track to meet the national and SDG2030 targets for Newborn health, notwithstanding this.
During a High Level Table Discussion on New Born Care conducted in Kampala by the Ministry of Health, the MRC/Uganda Virus Institute, and the Makerere School of Public Health officials highlighted both progress and ongoing challenges.
Fifteen years had passed since Uganda’s previous Situational Analysis (SITAN). New best practices in infant care as well as changes in mortality and epidemiology at the regional and national levels have happened since then.
The 2022 Uganda Demographic and Health Survey (2022 UDHS) reports that the neonatal mortality rate has decreased to 22 deaths per 1,000 live births from 27 deaths per 1,000 at the beginning of the study. Despite this progress, Uganda still falls short of the SDG2030 target of 12 deaths per 1,000 live births and the National Development Plan III goal of 19 per 1,000.
The latest UN estimates indicate Uganda faces 62,000 annual deaths related to childbirth, including 4,800 maternal deaths, 26,000 stillbirths, and 32,000 neonatal deaths. With 1.7 million births and 250,000 neonates needing special care annually, the investment in newborn care remains inadequate. Uganda has not met the 2020 targets for 80% postnatal care coverage and WHO level 2 newborn care units in 80% of districts.
Currently, Uganda is in the early phase III of the mortality transition framework, showing some improvements in maternity and neonatal care. However, the SITAN report emphasizes that to reduce perinatal mortality further, Uganda needs to expand access to intensive neonatal care and address the high fertility rate, particularly in areas like Karamoja and Bukedi, where rates are 6.7 and 6.5, respectively.
“There is a need for more targeted investments in key areas of infrastructure for newborns, human resources including neonatal nursing and improving staffing levels, medical commodities for newborns, and equipment and devices for newborn care,” emphasized the OMWaNA Trial report.
Hon. Margaret Muhanga, State Minister for Primary Healthcare, highlighted the significance of new evidence in newborn care, referencing the OMWaNA trial: “We need to consider new evidence in caring for newborns in Uganda. For example, the OMWaNA trial showed that Kangaroo Mother Care before stabilization is a cost-effective intervention for caring for preterm babies.”
Professor Joy Lawn, a Paediatrician and Perinatal Epidemiologist from the London School of Hygiene & Tropical Medicine (LSHTM), stressed the need for multiple interventions: “We need more than one intervention to save newborns vulnerable to infant mortality. Currently, 33,000 babies die before reaching 28 days, and 22,500 are stillbirths.”
Dr. Richard Mugahi, Assistant Commissioner of Reproductive and Infant Health, outlined strategic areas for investment: “We need more neonatal fellows—Uganda has only five neonatologists for 50 million people. We have zero neonatal nurses. We need very strong data and health informatics systems, health commodities, evidence-based supplies, investment in infrastructure, and equipment. When we do all those five, we can have a really very strong newborn program.”
Dr. Mugahi also noted improvements in maternal healthcare: “We now stand at 86% of deliveries in health facilities and 68% for the four antenatal visits and above. Quality antenatal care has a direct impact on maternal and newborn outcomes.”
Despite these improvements, significant gaps remain. “The Newborn Investment Case presents a strategic approach and financial blueprint aimed at mobilizing resources and guiding investments to improve newborn health outcomes, focusing on requirements for scaling up newborn care,” stated Hon. Muhanga.
The discussion underscored the urgent need for Uganda to enhance its efforts in newborn health to meet the ambitious national and international targets, ensuring healthier futures for its youngest citizens.