By Timothy Eodu
Select midwives from the districts of Amudat, Nakapiripirit, Nabilatuk, Napak and Moroto have completed a one week’s training on emergency response to obstetric operations, maternal and neonatal care, and gynecology among others.
The training which was held at Moroto Regional Referral Hospital last week brought together medical workers from the various Health Center IVs where the regional referral hospital made an assessment and found some gaps in the personnel skills to handle minor emergencies.
According to Dr. Denis Esayu, the Gynecologist and lead trainer at Moroto Regional Referral Hospital, the selection of the trainees was based on the reviews on referrals from their facilities (gaps identified) and support supervision at the units.
“Key members were picked from these facilities to be trained on management of obstetric cases, Maternal and Perinatal Death Surveillance and Response-MPDSR portal to track recommendations found during reviews of Perinatal or Maternal death but also hands on skilling in labour suit (PPH Management), cesarean section at the theater so that when they go back to the lower units they can be able to apply the knowledge thus reducing on the frequent referrals,” Dr. Esayu told Karamoja News.
He added that the training was supported by G-to-G (Government to Government funding) to the Regional Referral Hospital for quarterly capacity building and mentorship all over the region with a team already reviewing the backlogs of left out reviews in Northern Karamoja to ensure that recommendations are in place but also being implemented.
Dr. Esayu said this is helping the Regional Referral Hospital to improve health service delivery, especially Maternal and Neonatal such that emergency cases are handled in time and avoid past mistakes from reoccurring.
Dr. Stephen Pande, the Moroto Regional Hospital director said since its inception, the state of the art women’s maternity unit constructed by the Ministry of health at the facility has greatly improved Maternal and Neonatal services in the region.
He said the attendance of mothers seeking maternal services from within the region and neighboring districts but also across borders like Turkana and South Sudan has tremendously increased due to the improved services readily available.
He said most of the patients they receive are from lower units that are not operating as they are supposed to due to lack of skilled personnel, lack of proper infrastructure like mini theaters to handle minor operations.
“About 50% of these referrals come from Nadunget HCIV which even has the equipment and facilities to offer these kinds of services but unfortunately due to shortage of human resource and other requirements, they are unable to perform,” Dr. Pande said.
One of the midwives who preferred anonymity told KaramojaNews that at their facility, they lack a theater and yet a lot of cases they receive require operation but they are incapacitated and end up referring them to Moroto for further management.
She said due to the long distance to Moroto, and poor road networks; they sometimes register fatalities which have had a negative attitude towards seeking of such services from their facility but she was optimistic that with the training, they will do their best to help the mothers and children.
According to a 2018 study by Makerere University’s Centre of Excellence for Maternal, Newborn and Child Health on the state of Maternal and Neonatal Health in Karamoja region, in which 574 respondents were interviewed, the following were the findings;
Multiple partners and (multi-sectoral) interventions in the region (such as vouchers and food distributions) have improved service delivery and care seeking among expectant/mothers. However this is not the same for newborns – fewer newborns than mothers are seeking care at health facilities.
Maternal health: There is positive demand for services but this is limited mainly to ANC and delivery care. Of interest, almost 70% of the women attend ANC four times which is higher than the national average. Food distribution is an active incentive for ANC compliance.
The ANC content is generally good and 64% of the women delivered in a health facility. However, most women use natural remedies before visiting health facilities.
Also there’s low use of fansidar to prevent malaria in pregnancy (40%) and tetanus toxoid (37%). The pathway to care for most women includes preference for natural remedies before visiting health facilities postnatal care attendance is also very low. Newborn health: Health facilities have limited capacity for inpatient care for newborn and the young infant.
Illness recognition is poor and care seeking delayed. Despite 94% newborns receiving care outside the home, only a half do so within one day. Like in maternal health, neonatal care involves a fusion of medico-herbal practices. However some positive newborn care practices were noted to exist in Karamoja.
In patient care for newborns and sick young infants is inadequate. Almost all facilities mix sick newborns/young infants with the older child during admission care. Most facilities lack essential staff, skills, infrastructure, commodities and protocols for newborn care.
The referral system for sick newborn babies is also non-existent or is weak. Human resources capacity particularly numbers (currently at 50% staffing levels), specialized skills and tools for newborn care remain a great challenge – at both facility and community level.