Is facility based neonatal care in low resource setting keeping pace? A glance at  Uganda’s National Referral Hospital.

Yaser Abdallah, Flavia Namiiro, Jamir Mugalu, Jolly Nankunda, Yvonne Vaucher, Douglas McMillan
1. Department of Paediatrics and Child Health, Makerere University College of Health Sciences.
2. Department of Pediatrics, Division of Neonatal/Perinatal Medicine, School of Medicine, University of
California at San Diego, USA.
3. Department of Pediatrics, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia, Canada.

Abstract
Objectives: To identify reasons for neonatal admission and death with the aim of determining areas needing improvement.

Method: A retrospective chart review was conducted on records for neonates admitted to Mulago National Referral Hospital
Special Care Baby Unit (SCBU) from 1 st  November 2013 to 31st  January 2014. Final diagnosis was generated after analyzing sequence of clinical course by 2 paediatricians.

Results: A total of 1192 neonates were admitted. Majority 83.3% were in-born. Main reasons for admissions were prematurity  (37.7%) and low APGAR (27.9%).Overall mortality was 22.1% (Out-born 33.6%; in born 19.8%). Half (52%) of these deaths  occurred in the first 24 hours of admission. Major contributors to mortality were prematurity with hypothermia and respiratory  distress (33.7%) followed by birth asphyxia with HIE grade III (24.6%) and presumed sepsis (8.7%). Majority of stable at risk  neonates 318/330 (i.e. low APGAR or prematurity without comorbidity) survived. Factors independently associated with death  included gestational age <30 weeks (p 0.002), birth weight <1500g (p 0.007) and a 5 minute APGAR score of < 7 (p 0.001).  Neither place of birth nor delayed and after hour admissions were independently associated with mortality.

Conclusion and recommendations:Mortality rate in SCBU is high. Prematurity and its complications were major contributors
to mortality. The management of hypothermia and respiratory distress needs scaling up. A step down unit for monitoring stable  at risk neonates is needed in order to decongest SCBU.

Keywords: Neonatal care, Uganda’s National Referral Hospital