Mothers waiting for their preterm babies to be placed in incubators at Kitgum General Hospital neonatal ICU – Photos by Daniella Lagum
By Daniella Lagum
Kitgum: The Neonatal Intensive Care Unit (NICU) at Kitgum General Hospital is overwhelmed with the increasing number of preterm babies seeking care services at the facility.
Preterm babies are born before the completion of 37 weeks of pregnancy. Preterm births are categorized based on gestational age: including extremely preterm (less than 28 weeks), very preterm (28 to less than 32 weeks), and moderate to late preterm (32 to 37 weeks).
Such births are caused by spontaneous preterm labor or due to a medical condition that induces early labor or prompts an emergency cesarean section birth, birth asphyxia, and low uptake of antenatal health services during pregnancy.
In 2018, the Ministry of Health with support from development partners established and equipped the NICU unit at the hospital, following an increasing need for specialized services for preterm babies who were referred to hospitals in Gulu, Lira, or Mulago National Referral Hospital.
The unit has four cubicles, each with three beds meant to accommodate 12 preterm babies at a time.
However, Dr. Geoffrey Okello, the medical superintendent at Kitgum General Hospital, said that the unit currently hosts between 30 and 40 preterm babies, as they spend months at the unit.
The NICU is also constrained in terms of bed capacity, space, equipment, and human resources.
Dr. Casta Robert Ouma, a pediatrician attached to the unit said that because of the insufficient bed space, there is congestion, and patients are attended to in shifts, depending on the severity of each case.
Dr. Ouma said the situation is putting pressure on the limited equipment such as radiant warmers, baby warmers, incubators, monitors, fluid pumps, and oxygen concentrators among others.
The shortage of basic equipment sometimes prompts medics to make three to five babies share equipment including oxygen concentrators concurrently.
Dr. Ouma said that this practice may expose them to high infection risks since preterm babies have different complications.
Records at Kitgum General Hospital indicate that the neonatal infection rate in the hospital is 39.6%, more than double the national rate which is 17%.
Human resource challenges
Currently, the unit has only four specialized health workers enrolled by the government to operate at the facility.
The national standard demands each nurse attend to two babies, but the hospital currently has one nurse attending to 15 preterm babies.
Mothers and caregivers reiterate
Speaking on condition of anonymity, a mother who resides in Kakwanga village in Lubalangit Sub County, Karenga district said that low birth weight babies due for discharge share one photo-thermal warmer.
According to the source, the situation is compounded by frequent power outages.
Nancy Oketayot who is taking care of her daughter-in-law and granddaughter with a low weight, said that the unit is congested with limited beds.
Oketayot who has been at the hospital for five weeks, revealed that mothers and caregivers sleep on the floor.
Sister Grace Atim, a neonatologist and the Unit In-Charge explained that the unit is always congested because of the increasing number of referrals from distant places, and because preterm babies require ample time for treatment.
According to Sr. Atim, the unit receives referrals from the neighboring districts of Lamwo, Pader, Agago, Karamoja, parts of Lango sub-region, and South Sudan.
The Kitgum District Health Officer, Dr. Henry Okello Otto, said that they are seeking interventions from the government and partners to equip the facility and add human resources to mitigate the problem and reduce preventable newborn mortality.
Data at the hospital show that 448 preterm babies were admitted in 2019, while 560 were admitted in 2020, although admissions drastically declined to 233 in 2021 due to the COVID-19 outbreak.
Data for 2022 and 2023 admissions were unavailable.
Dr. Okello, however, said despite the overwhelming number, the facility has since its inception saved 2,112 live babies, five of whom were less than 500 grams during admission.
Neonatal mortality rates
According to the World Health Organization (WHO), the neonatal mortality death rates of children under five years globally stand at 38 deaths per 1,000 live births, far above the predicted 12 neonatal mortality deaths target set to achieve the Sustainable Development Goals (SDGs) by 2030.
Dr. Ouma, however, said that the neonatal mortality in Kitgum district for children under five years was at 29 deaths per 1,000 live births in the year 2023, far above the national statistics of 22 deaths per 1,000 live births.
Neonatal deaths are due to prematurity, complications in breathing and feeding, poor body temperature maintenance, complications during birth, complications of sepsis infections acquired from the environment and the uterus, and infections linked to pneumonia, tetanus, and diarrhea.
According to the Ministry of Health guidelines, preterm management involves offering emergency care to underweight babies, excessive warming and thermal care, managing respiratory distress and oxygen therapy, counseling to parents on which drugs to be given as first, second, or third line and what point of treatment should be changed, treatment of the underlying cause (such as malaria), as well as constant follow up care after discharge.
