Every newborn and mother should thrive through the time between conception until the fifth birth day and life beyond, when the mother conceives again and when the newborn turns into an adult. Uganda still experiences grievous neonatal and maternal birth outcomes and struggles in a weak health system. WHO recommends countries to raise their profile on preconception care through; active promotion, creating awareness on its benefits and incorporation of the package in the continuum of care.
Study objectives
- To explore the policy and program context of preconception health/care in Uganda.
- To pilot an intervention package on interconception care among mothers receiving health care services in Luuka District.
Study Methods
MakSPH with funding and support from March of dimes is implementing two year (2018-2020) phased study nested in COMONETH Project – Luuka District. This will include a desk review of existing literature (published and unpublished), conducting key informant interviews with MNCH local experts. A short baseline evaluation to understand the current interconception care received by mothers in Luuka District will done. A cohort of 300 women will be followed to understand the type of care received from when the deliver to a time of the next conception. A preconception health care package will be designed and piloted. This will entail integrated of the package into the districts maternal and newborn care program and documentation will made through a close track of progress during the pilot phase.
Preliminary findings: Preconception care is still neglected in Uganda’s health care system and available literature is still scanty. Uganda has no policy on preconception health and care. There only exists highlights of guidelines on preconception care embedded in other national guidelines on; (i)Maternal nutrition, (ii) Reproductive health and rights. There is a stronger component of ANC, and postnatal care (from when a baby is born until 6 weeks) in the continuum, with a missing link between postnatal and the time when the mother conceives again.
Coverage of key indicators is still poor; preterm birth rates stand at 13.6 per 1000 live babies, 50% of newborn deaths results from adverse risk in pregnancy, 5.4 fertility rate, 34.8% contraceptive prevalence rates, 43% unintended pregnancies, 25% teenage birth rates, 1% use the ideal doze of folic acid despite 31% Anaemia prevalence in pregnant women and 5.1 months is the medium duration for 1st ANC. Communities and health workers have limited knowledge on consequence of pregnancy risks and importance of interventions; a determinant to health care seeking. Contributing/pregnancy risk factors to neonatal deaths in Uganda include; unplanned/short birth intervals pregnancies, teenage pregnancies, medical conditions (HIV, STIs, Diabetes mellitus, hypertension, sickle cell), malnutrition, parity of +5, malaria in pregnancy, antepartum and intrapartum anaemia, pre-eclampsia, non-facility deliveries and poor birth monitoring, immunisable diseases, Infectious diseases and environmental smoke exposure.
Having preconception health and care prioritised and given equal attention as a package in the continuum of care contributes to the reduction of avoidable pregnancy risks related to pregnancy complications and outcomes. This study is among the very few studies on preconception health and care in Uganda and will test the possibility of integrating preconception services/interventions into the districts health system and its uptake at community level.
Team Leader: Prof Peter Waiswa | pwaiswa@musph.ac.ug
Co- Team Leader: Mr Nathan Isabirye | isabiryenathan5@gmail.com