The District Medical Officer has welcomed the NICHE International team to Kabale to carry out this training. The WHO Uganda update from April 2025 (The health of mothers and babies is the foundation of healthy families and communities | WHO | Regional Office for Africa) states that Uganda’s maternal mortality ratio (MMR) stands at 189 per 100,000 live births, with a one (1) in 66 lifetime risk of maternal death. In Kabale, maternal mortality is slightly less but still stands at a shocking 163 per 100,000. The neonatal mortality rate (NMR) nationally has decreased from 27 to 22 per 1,000 live births but remains above the SDG target of 12 per 1,000 live births. Teenage pregnancies contribute significantly to mortality, with one (1) in 4 girls aged 15-19 pregnant or already mothers, accounting for 20% of overall maternal deaths.
Facility data in Kabale show a significantly higher neonatal death rate of 33 per 1,000 live births. Over 70% of neonatal deaths occur within the first week of life, with a substantial proportion occurring on the day of birth. The leading direct causes here mirror those listed in the WHO document and include birth asphyxia (49%), complications of prematurity (14%), and neonatal sepsis (12%), indicating critical gaps in intrapartum care, immediate newborn care, and early postnatal monitoring.
The course covers all the topics known to decrease the risk of newborn babies’ risk of dying in that first week and so far has been well received by enthusiastic candidates! Significant learning, as fed back by them, has included: inflation breath techniques, how to be confident with intraosseous access and how useful an ABC approach is. The infection session and antibiotic use sparked much discussion about early and easier availability of broad spectrum antibiotics in some of the districts. Skin to skin was another highlight especially with the doctors who hadn’t appreciated all its benefits.
We talk about the use of Early Warning Scores to pick up early signs of sepsis which the clinicians in Kabale were not used to using. Elizabeth was able to explain how she has introduced this into the paediatric ward in Bwindi Community Hospital with good effect. The credibility of the Neonatal Care Course is hugely enhanced by having local instructors teaching on it. We are blessed to have such wonderful colleagues to learn with and from.