Maternity
In 2022 there were just under 2000 deliveries at Kagando, including 60 sets of twins. Sadly stillbirths are quite common (80) and 40 babies died shortly after birth. About 57% of deliveries in the hospital are by Caesarean section. This is an extremely high rate, and various factors are involved.
Firstly, Kagando is a referral centre, with over a quarter of the women admitted coming from other health centres and hospitals, either because they are at high risk or because there are already complications in labour. Many women with low risk pregnancies will deliver either at home in the village or at their local health centre, and do not appear in these statistics. Anyone who is likely to need help during labour will be advised to come to Kagando.
Secondly, if a woman has had one Caesarean she will often have a ‘trial of labour’ in her next pregnancy and may well have a normal delivery. After 2 Caesareans the risk of problems increases, and she will almost always be advised to have surgery for any further pregnancies. People here have large families; 10+ children is not unusual, so some women have had 6+ Caesareans. Almost unheard of in the UK, and very high risk!
Thirdly, malaria is common and dangerous during pregnancy; it can cause miscarriage or premature labour, and can severely reduce blood flow to the placenta. In cases of severe malaria it is vital that the baby is delivered as soon as possible to avoid brain damage due to lack of oxygen.
During 2022 there were 8 Maternal deaths. 4 of these patients had been transferred in from other units. 4 deaths were from haemorrhage, one from malaria, and one from a ruptured uterus – a complication usually due to lots of previous Caesareans.
Neonatal Intensive Care Unit (NICU)
10 year ago Chris Harris, now a Paediatrician in London, spent a year at Kagando. Working with the paediatric nurses he shared their frustration at the limits of what they could do for the many sick babies in their care. He worked with them to develop the neonatal unit into one of the very best in East Africa by training staff, working out protocols appropriate for rural Uganda, and especially by sharing their determination to provide excellent care, even in a resource poor setting. Several staff have completed specialist Neonatal training, and the unit is led by the nurses, with support from junior doctors and the Paediatrician.
Like the Maternity unit, Kagando’s NICU is a referral unit for the whole area. A total of 506 babies were cared for in NICU last year. 60% of these were premature, and I met a thriving ‘Miracle Baby’, now aged 4 months, who had been born at 26 weeks weighing only 700g. Other problems include birth asphyxia (sometimes leading to cerebral palsy), sepsis, jaundice, pneumonia, and congenital abnormalities. Sadly 91 of these babies died.
A worrying time for parents
