Understanding stillbirth prevention strategies at sub-national level in Uganda
Eric Ssegujja (1,2), Michelle Andipartin (3)
(1) Makerere University School of Public Health, Kampala Uganda; (2) University of Western Cape, School of Public Health, South Africa; (3) University of Western Cape, Department of Psychology, South Africa
The global response to stillbirth stemming from the 2011 Lancet stillbirth series “call to action” have had a lasting impact on prevention strategies in regions with the highest-burden. With decentralization of health services and a call to the integration of strategies have seen many of these strategies translated at a subnational level where implementation takes place. However, documentation of such experiences is still lacking. This paper illuminates the translation experiences of stillbirth prevention strategies in a single district case in Uganda.
A cross-sectional descriptive study was conducted in a single district case with relatively high stillbirth rates in Uganda. Qualitative interviews with a purposively selected sample of 15 key informants including health workers, facility and district managers were conducted. Data were audio-recorded and transcribed verbatim with the content analysis done using Atlas ti.
A heightened vigilance towards stillbirth burden influenced the nature of the response by re-orienting service provision towards better management. Adapted strategies from MoH and implementing partners were merged to define the stillbirth prevention package. Key strategies were centered at the district like improved data capture, health worker training, regular perinatal review and geographical prioritization of high burden areas. Facility level strategies were proper documentation and review of management practices, operationalizing of referral system, increased vigilance during screening, management of high risk mothers by specialists at no extra cost. Community strategies aimed at creating demand for ANC services by linking mothers through VHT referral forms and availing a toll free line for easy communication.
Targeting the different levels helped focus strategies to different risk factors and implementation challenges highlighting the potential of these strategies to reduce stillbirth burden.
Ethics approvals from University of Western Cape Biomedical Research Ethics Committee (BM/17/9/1), Makerere University School of Social Sciences Research and Ethics Committee (MAKSS REC 12.17.110) and Ugandan National Council for Sciences and Technology (SS 4575) were obtained. Permission from the district authorities and individual written consent were secured before interviews. Respondents’ safety was ensured by clarifying purpose of the study, conducting the interviews in a secure and quiet location, anonymizing data and keeping it on a password protected computer only accessed by the study team.
Keywords: stillbirth, prevention strategies, subnational level