Summary
Since 2018, Knowledge for Change (K4C) has undertaken high-impact work on antimicrobial stewardship and wound management at Fort Portal Regional Referral Hospital (FPRRH). This has demonstrated the efficacy of a multi-disciplinary team approach to complex healthcare problems. It empowered nurses, midwives and pharmacists to lead pragmatic, bedside approaches to care within a low-resource setting, and resulted in the sustained reduction of maternal deaths due to sepsis within the hospital over the last six years.
This programme of work will extend this successful model to address the significant problem of neonatal morbidity and mortality. Neonatal sepsis is the 3rd most common cause of neonatal mortality in Uganda, leading to over 18% of all neonatal deaths. Neonatal deaths due to sepsis have been increasing at FPRRH throughout 2023. This has been attributed to a multitude of factors including:
- Poor infection prevention and control (IPC) mechanisms on labour ward and postnatal ward
- Supply chain issues
- Lack of appropriate prophylactic antibiotics for high-risk mothers in labour
- Poor practice around vaginal examinations including multiple unnecessary vaginal examinations
K4C received a £50,000 grant from NHS England (NHSE), via the Tropical Health Education Trust (THET), to establish our neonatal sepsis project in Uganda between 1st January 2024 until 30th June 2025. Although the NHSE funded project only includes Uganda based activities, K4C is utilising an additional £12,600 of its own internal funding to extend the project to also include Mnazi Mmoja Hospital (MMH) in Zanzibar (Tanzania).
Objectives
This programme of work will extend and expand our previous successful maternal sepsis intervention to address the significant problem of neonatal morbidity and mortality. By implementing a complex intervention along the neonatal inpatient continuum, this work aims to prevent, identify and effectively manage neonatal sepsis to prevent harm and death through orientation and empowerment of the multidisciplinary health worker team.
The overall aim of the project is to develop a comprehensive, effective and scalable ‘Orientation Package’ which can be used to train and build capacity of medical, clinical officer, nursing, midwifery and pharmacy staff at 4 health facilities in Uganda including Fort Portal Regional Referral Hospital (FPRRH) and Kasangati, Kataraka, Bukuuku and Kagote Health Centres, as well as Mnazi Mmoja Hospital in Zanzibar. Once developed, the Orientation Package will be initially piloted and evaluated at FPRRH, before being refined then rolled out more widely to the other health centres and MMH.
Activities
This project is taking a holistic approach to tacking the problem of neonatal sepsis. The first step in the project involved identifying the key causes of neonatal sepsis within the Ugandan
and Tanzanian contexts. A comprehensive benchmarking process was undertaken to review hospital and patient records, and a series of case review meetings was held at each health facility to identify any challenges faced in preventing, diagnosing and treating neonatal sepsis. The case review meetings were attended by multidisciplinary and multinational teams of staff from each health facility.
The information gathered has been complemented by prior learning gained from our previous maternal sepsis intervention to guide the design of a series of 5 high quality, effective and scalable training packages:
1. Respectful Maternity Care (prevention of sepsis)
2. Infection Prevention and Control (prevention of sepsis)
3. Patient Management and Referral Pathways (identification of sepsis)
4. Management of Sepsis (treatment of sepsis)
5. Antibiotic Stewardship (treatment of sepsis)
The design of these training packages will be completed by the end of December 2024. They will then undergo a piloting and review process before the official roll-out begins in January 2025. The project is subject to a comprehensive, ongoing evaluation and results will be shared in due course.