Saving Newborn Lives: A preemie’s survival
story in northern Uganda

Preventing Deaths from Premature Births

Just 28 weeks into her pregnancy, Susan Ayam, a 26-year old primary school teacher from northern Uganda, started feeling pain in her lower abdomen. Although Susan had been to the health center three times already for her antenatal care visits, each time she was told the baby was well and progressing normally. Since she had not felt any discomfort during the first six months of her pregnancy, she at first didn’t get alarmed when the pain started. However, she soon started bleeding, too, and immediately told her husband, who rushed her to the nearest health center. After a 30-minute bumpy ride on a motorcycle, they reached the health center a little after midnight.

“When we got to the health center, the midwife on duty examined me, and informed us that I was in labor, and that one of the baby’s feet was already coming out and they had to deliver it preterm,” said Susan.

Susan was no stranger to preterm babies. Her second child, Fortunate, now three years old, had been born two months early. Even with her previous experience, the mother of three said the second encounter was harder. The circumstances surrounding the birth, the baby’s weight, and the COVID-19 health restrictions, made it more exhausting physically, emotionally, and economically for the family.

Calvin, Susan’s husband, helps carry baby Faith using the Kangaroo Mother Care method that is recommended to keep preterm babies warm and to nurture the bond between baby and parent.

“My baby was only 1.2 kgs when she was delivered. I was immediately referred to the neonatal intensive care unit (NICU) at Lira Regional Referral Hospital because the baby wasn’t breathing well,” Susan explained. Upon admission at the NICU, baby Faith was resuscitated, put in the incubator, and placed on continuous positive airway pressure therapy (CPAP) to help her breathe.

The baby was kept in the intensive care for more than three weeks. During their stay at the hospital, Susan was counselled on how to take care of a preterm baby.

“Faith was in critical condition, was too small, and had difficulty breathing. After five days in the NICU, her weight dropped to 800 grams. I was scared I would lose her, but the doctors trained me on how to feed the baby through a tube, how to express milk, and how to use the kangaroo method of warming the baby,” said Susan.

Susan’s story is one of many in the region. Every year, about 2,800 babies in northern Uganda’s Lango sub-region are born before their expected date of birth. Preterm birth is a major cause of NICU admissions and newborn deaths across Uganda. This is due to health system factors including limited number of specialized units such as NICUs, inadequate machines (e.g., monitors, incubators, and CPAPs), and a knowledge gap among health workers about how to handle babies born too soon. Other challenges include long distances between referring facilities and an overwhelming number of preterm babies born each year.

The USAID Regional Health Integration-North, Lango Activity (RHITES-N, Lango), supports facilities such as the Lira Regional Referral hospital to prevent deaths from premature births. At lower-level health centers, RHITES-N, Lango trained health workers to provide essential newborn care and make timely, appropriate referrals using pre-referral guidelines. This ensures that preterm babies don’t die from preventable causes such as infections and hyperthermia while in transit. At higher-level health centers, general hospitals, and the regional referral hospital, RHITES-N, Lango supports kangaroo mother care units, newborn corners, and NICUs. The activity provides newborn resuscitation equipment, trains and mentors health workers to manage the care of preterm babies, and supports initiatives to improve the quality of care for newborns.

Calvin and Susan with their three children, Fortunate, Abednego, and Faith.

This support has helped save many babies like Faith. Three months later, she now weighs three kilos, can breastfeed and breathe well on her own, and has not had any more complications.

RHITES-N, Lango’s efforts have contributed to a reduction of preterm deaths. Although preterm deliveries average 46 percent of all NICU admissions over the last three years at the Lira Regional Referral hospital, death from prematurity and its complications have reduced from an average of 64 percent in 2019 to 45 percent in 2020.

Story by Angela Kateemu and Dr. Denis Kintu