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School of Public Health
College of Health Sciences, Makerere University

A joint study by Makerere and Oxford University found an urgent need for interventions to improve continuity of care for preterm infants after hospital discharge

Posted on : Sunday, March 27, 2022

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A study by the Makerere University School of Public Health (MakSPH) in partnership with National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health (NDPH) at the University of Oxford found that there is an urgent need for interventions to improve continuity of care for preterm infants after they are discharged from the hospital. The study conducted between January 2019 and April 2020 in Iganga and Jinja district hospitals in Eastern Uganda sought to find ways of providing support to caregivers of babies who are born very early (preterm), particularly after the baby is discharged from the health facility.

On average, 200,000 babies are born preterm each year in Uganda. Complications of prematurity account for 38% of neonatal deaths. Dr. Christine Nalwadda Kayemba, a Senior Lecturer and Head, Department of Community Health and Behavioral Sciences at MakSPH said that the study findings of lack of continuity of care could explain the higher mortality of preterm babies in the community after discharge from health facilities.

The Preterm Birth Initiative (PTBi) project from Busoga subregion of Uganda showed 11.3% to 28% post-discharge deaths among preterm babies. Dr. Nalwadda, who is also Co-Principal Investigator of the study said that there are no established interventions in Uganda to support parents of preterm babies to provide recommended care at home after hospital discharge.

Keeping the baby warm, appropriate feeding, infection control, and recognising early warning signs are essential for preterm babies. However, the study conducted among 240 caregivers of preterm babies showed significant differences in care provision at home. Although 98% of the parents received advice from healthcare providers at discharge, there was a variation in the advice received such as the frequency of Kangaroo Mother Care for keeping the baby warm. Further, very few mothers received advice on recognising danger signs to seek early medical care for the baby.

As a result, at home after discharge, close to 60% of the mothers said that they found it difficult to keep the baby warm, and more than half said it was difficult to recognise the danger signs. On the whole, 64% of babies developed symptoms of illness at home and 27% of the babies were re-hospitalised.

The study team interviewed 56 caregivers, who were mainly parents, to understand their experiences of caring for a preterm baby at home after being discharged from the health facility. A majority said that there was no clear path for continued support at home and that one scheduled visit to the hospital, was too little and not enough. Others mentioned that they were not aware of the baby’s needs, danger signs and where to seek help and treatment when the need arose. Parents also complained about the costs of medicines and supplements which they have to buy while at the hospital and after discharge.

Although healthcare workers were a trusted source of information, mothers did not feel entirely trusted by healthcare workers while fathers felt left-out from the start as there was very little communication with them and they were provided limited or no information.

The study findings were shared and discussed with parents of preterm infants, healthcare providers, policy makers, academics and other key stakeholders at local and national meetings. Three strong recommendations emerged:

(i)  Community health workers (VHTs) could work with peer-supporters to provide continued support to parents after the preterm baby is discharged from the health facility.  Peer-supporters will be parents who have a previous experience of caring for a preterm baby.

(ii) Medicines and supplements required for preterm infants should be added to the national list of essential medicines.

(iii) Both men and women need to be sensitised on preterm baby care prior to discharge.

Associate Professor Manisha Nair, Co-Principal Investigator from Oxford, said that the recommended intervention to improve continuity of care for preterm babies at home after discharge will have to be developed and tested with input from parents, health workers, VHTs, NGO partners, policy makers and community leaders through an iterative process.

The Investigators include; Dr Christine Nalwadda Kayemba and Assoc Professor Peter Waiswa, from the School of Public Health, Dr. Harriet Nambuya, from Jinja Regional Hospital, Dr. David Muwanguzi, Iganga District Local Government and Dr Joseph Okware from the Ministry of Health, Uganda.

At the University of Oxford, Associate Prof. Manisha Nair and Professor Jenny Kurinczuk of the NPEU, Nuffield Department of Population Health (NDPH) and Professor Maureen Kelley of Ethox Centre, NDPH.

The study was funded by a Nuffield Department of Population Health pump-priming award.

Written by Judith Grace Amoit & Melody Kukundakwe

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