A pilot study to determine if nurses trained in basic neonatal resuscitation would impact the outcome of neonates delivered in Kampala, Uganda.

AIMS AND OBJECTIVES: To determine if a team dedicated to basic neonatal resuscitation in the delivery ward of a teaching hospital would impact the outcome of neonates delivered in Kampala, Uganda. METHODS: A five-member team of nurses, trained in basic neonatal resuscitation attended 1046 deliveries over a thirty-one day pilot period. They were available in the delivery ward twenty-four hours each day. Outcomes studied included the number of stillbirths recorded on the delivery ward, the number of neonates admitted to the special care baby unit (SCBU), the number of babies admitted to SCBU who died and the mortality in the different weight categories. APGAR scores before and after intervention was also compared. Admission diagnoses between the two groups were also compared. Outcome data collected during this pilot period was compared with historic controls from the previous 31 days in the same unit. PATIENTS AND SETTING: A delivery ward, 22,000 deliveries per year. RESULTS: The stillbirth rate and admission rate to the SCBU were unchanged. Basic neonatal resuscitation in this setting decreased the incidence of asphyxia (defined as failure to initiate and sustain breathing or an APGAR score of <7 at 5 min), improved APGARS and a decrease in the mortality of babies weighing more than 2 kg. CONCLUSION: The resuscitation team reduced the incidence of and mortality from asphyxia and improved the outcome of babies greater than 2 kg. This pilot study provides evidence of the beneficial effect of basic neonatal resuscitation in this setting.

Home-based care for orphaned children infected with HIV/AIDS in Uganda.

The primary aim of this paper is to describe an outreach programme from a main state hospital in sub-Saharan Africa, which has been running for three years. This programme is based in Mulago Hospital, Kampala, Uganda and cares for up to 200 children infected with HIV/AIDS in their home. We describe the clinic and how we meet the families and enrol them, the infrastructure of the programme and the personnel involved. Children and their families receive physical, psychological and social care and we describe each aspect of this. The knowledge base about older children with AIDS in Africa is scarce and the secondary aim of this paper is to publish observations that were made while providing care. This includes demographics and the health problems encountered among children living with HIV/AIDS in a resource-poor setting who do not receive antiretroviral medication. Finally, we discuss the strengths and weaknesses of this model of care and the prerequisites to setting up a similar model.