Neonatal Infectious Diseases in Low-Resourced Countries - The Ugandan Experience
Margaret Nakakeeto, Consultant Paediatrician and Neonataologist at the Mulago National Referral Hospital in Kampala Uganda, presented an inspiring talk on the needs and potential for neonatal care in Uganda (Figure 7.1).
Dr. Nakakeeto described the Mulago National Referrral Hospital (Figure 7.2) which is a relatively modern hospital however Dr. Nakakeeto also pointed out that neonatal services in Uganda are deficient because of the absence of clear policies and specific sources of funding.
In Uganda there are 1.4 million deliveries a year, with skilled personnel in attendance at only 39 per cent. The anomaly is that Uganda has resources that could be applied to neonatal care (Figure 7.3). Dr. Nakakeeto thinks that priorities for neonatal care are not adequate (Figure 7.4) and this relates to the absence of defined policies and correct resource allocation.
Neonatal sepsis is thought to be common in Uganda with prevalence rates 20 times higher than in high income regions, however most deaths occur at home and there is no data collection system in place at community level.
The organisms Dr. Nakakeeto believes are responsible for neonatal sepsis in her region are shown in Figure 7.5. These are preliminary data because diagnosis is difficult in Uganda due to limited laboratory facilities. Treatment of neonatal infections includes gentamycin and ampicillin and ceftriaxone for meningitis.
A surveillance study in 1999 found 2648 cases of neonatal tetanus.
Despite resource and organizational limitations a study of prevention of neonatal infections was undertaken at the Mulago Hospital (Figure 7.6). This resulted in improvement in the situation (Figure 7.7).