Roma, 15 dicembre 2012 - Medici con l'Africa Cuamm presenta il progetto "Prima le mamme e i bambini - I primi passi: risultati, innovazione e ricerca". Nelle slide la presentazione del caso Uganda.

1. Mothers and Children First:
The case of Uganda
Peter Lochoro MBChB, MSc
Country Representative
Doctors with Africa CUAMM, Uganda
Prima le mamme e i bambini 15 dicembre 2012 II caso Uganda

2. Uganda – Oyam District
Prima le mamme e i bambini 15 dicembre 2012 II caso Uganda

3. PL1

4. Diapositiva 3
PL1 Explain the diagram and the Italian version
Peter Lochoro CUAMM Uganda; 15/12/2012

5. PL2
Signal Functions for Emergency Obstetric
and Neonatal Care, Oyam District
Aber Hospital is the only
health unit which provides all 9
signal functions. Therefore it is
qualified as comprehensive
emergency obstetric care
(CEmOC)
None of the health centres
provide all 7 signal functions
to qualify as Basic Emergency
Obstetric Care (EmOC)
The most missing signal
function is “Assisted vaginal
delivery (i.e. use of vacuum
extraction, forceps)
Instrument used:
Need assessment of emergency and neonatal care,
Columbia University, AMDD 2011.
Prima le mamme e i bambini 15 dicembre 2012 II caso Uganda

6. Diapositiva 4
PL2 Need to explain HC 1-6 and diagram
Peter Lochoro CUAMM Uganda; 15/12/2012

7. Quality of maternal and neonatal
care, Aber Hospital
.
Instrument used: Assessment tool for the quality of hospital care for mothers, newborn and child, WHO 2009.
Prima le mamme e i bambini 15 dicembre 2012 II caso Uganda

8. Quality of maternal and neonatal
care, Aber Hospital
Substantial improvements necessary to prevent
serious risk to the health of mothers and new borns.`
Issues: Sick newborn care, nursery, Guidelines,
protocols, auditing:
Improvements necessary to avoid risks for the
health of mothers and new born
Issues: 1. Organisation: Infrastructure, equipment,
supplies, laboratory, access, HIS. 2. Clinical: Maternal
care (normal delivery and obstetric complications)
Neonatal care (routine), Mothers and newborn follow-
up
Improvements necessary to mininmize potential
risks for the health of mothers and new born
Issues: Drugs availability
Prima le mamme e i bambini 15 dicembre 2012 II caso Uganda

9. Equity Aber Hospital, Oyam
District
77% of women who
delivered at Aber Hospital
belong to the richest
quintile, while none
belong to the poorest
quintile
40% of women who
delivered at health centres
belong to the richest
quintile, while 10% belong
to the poorest quintile
Instrument used: Proxy Wealth Index,
Demographic Health Survey
Uganda 2006.
Prima le mamme e i bambini 15 dicembre 2012 II caso Uganda

10. Indicators of Emergency Obstetric
care, Oyam District
Acceptable
Indicator
standard Oyam
1a. Number of cEmONC facilities 1 1
1b. Number of bEmONC facilities 3 0
2. Proportion of all births in EmONC facility None set 12.4%
3. Population based caesarean section rate 5-15% 2.4%
4. Direct obstetric case fatality rate in EmONC
<1% 1.5%
facility
5. Intrapartum and very early neonatal death rate
None set 2.8%
in EmNOC facility
6. Proportion of maternal deaths due to indirect
None set 33.3%
causes in EmONC facility
Prima le mamme e i bambini 15 dicembre 2012 II caso Uganda

11. Conclusion
• The project is beginning to get results
• Now we are more knowledgeable about the gaps in
quality, equity, coverage and we have a basis for specific
actions for improvement
• Gaps in Signal functions for EmONC persist and we
need to address them; esp. assisted vaginal del, use of
anticonvulsant, to get HC IV fully functional
• Quality gaps are mainly in Sick newborn care, nursery,
Guidelines, protocols, auditing:
• We are not yet serving the people we intend to reach
Prima le mamme e i bambini 15 dicembre 2012 II caso Uganda