Every year 45,000 babies die in the first month of life in Uganda, with an equal number of stillborns. The risk of death is five times that for babies born in the United States. The situation is much worse for babies born at home, without a skilled attendant, or in poor rural areas, such as the Rakai and Kyotera Districts where the Babies and Mothers Alive (BAMA) Program is working every day. The reasons for this tragic loss of life are the same throughout sub-Saharan Africa, lack of oxygen for babies at birth or during labor (fetal distress), infection, and prematurity. Often, relatively low-cost interventions can make a significant impact in reducing the loss of life and serious injuries affecting the long-term health of thousands of babies. For example, treating hypothermia, keeping a baby warm in the first few minutes after birth, can often mean the difference between life and death. Providing the knowledge and skill to perform basic resuscitation for babies struggling to breathe can also be a lifesaving intervention.
Over the past three years the BAMA Program has been working in 48 health centers and hospitals to improve the quality of newborn care in our two districts. In 2019, we are intensifying our efforts to dramatically reduce newborn mortality and morbidity. In 2016, our work to improve the health of mothers and their babies began with the training and mentoring of all of the physicians and midwives engaged in maternal and newborn care. Having a skilled attendant at every birth is critical to reducing both maternal and newborn deaths in our communities. Starting in 2017, we began the training of mentor midwives, who are part of the Ugandan health system, and are now the core of our training and mentoring program. To date, 30 mentor midwives have been trained to ensure that the quality of care at all of our partnering health facilities remains high. In 2018, with the support of Dr Leah Hodor and Vital Health Africa, we focused on life-saving skills to help babies breathe in the first minutes of life. Through community outreach, we have worked to increase the utilization of health center and hospital deliveries, knowing that home deliveries, without a skilled attendant, are a major contributor to the increased risk of death for both mothers and babies. Our 100 Mama and Papa Ambassadors, trained community health workers, encourage all pregnant women to develop a birth plan that includes delivering at one of our partnering health centers or hospitals. In 2016, the percentage of mothers having a skilled attendant at birth in Rakai and Kyotera Districts was 66% and 76% respectively. By the end of 2018, it has risen to 78% and 87%.
In 2019, we have several exciting initiatives which will save the lives of more babies.
Neonatal Intensive Care Units
For the first time in our districts of a half million people we have established Neonatal Intensive Care Units at our two District Hospitals. From January 1st to February 10th eleven babies were admitted to our NICUs, with no deaths thus far.
Adolescent-Friendly Health Services
Stillborn and newborn deaths are 50% higher among teenage mothers in Uganda than mothers aged 20 to 29. In addition, among infants of Ugandan mothers who have not completed secondary school, 35% are stunted, 52% are not on track for literacy and numeracy development between ages 3 and 6, and 45% are not on track for socio-emotional development between ages 3 and 6. Adolescents who are pregnant are often marginalized in rural Uganda, leaving their infants particularly vulnerable to poor outcomes. This year, with the support of the Grand Challenges Canada Saving Brains Program, we have established adolescent-friendly antepartum and postpartum services at our two District Hospitals. We know that 82% of women who receive full antenatal care will deliver at our partnering health facilities where staff have received BAMA training.
Oxygen Saves Lives
Throughout the developing world, millions of patients lack access to therapeutic oxygen, which is often the difference between life and death. Oxygen is an especially important treatment for millions of newborns requiring short-term respiratory support in order to survive. In 2019, we will partner with the Australian-based FreO2 Foundation. FreO2 has developed an off-the-grid oxygen concentrator that supports the availability of oxygen therapy even in remote and under-resourced rural health facilities. At Brick by Brick, we know that as a community-based organization with limited resources, we need to identify innovative partners who share our vision of health care as a right and not a privilege.
The health challenges facing millions of mothers and babies are complex and rooted in chronic poverty and insufficient investment in health globally. Over the past four years we have taken great strides in improving the quality of maternal and newborn care, building strong partnerships with district government and our dedicated cadre of health providers. 2019 looks to be a year of continued progress.
 Situation analysis of newborn health in Uganda: Current status and opportunities to improve care and survival Ministry of Health. Situation analysis of newborn health in Uganda: current status and opportunities to improve care and survival. Kampala: Government of Uganda. Save the Children, UNICEF, WHO; 2008.