Medical researcher Dr Lawrence Mwananyanda says there is need to reduce the mortality rate at the Neonatal Intensive Care Unit (NICU) at the University Teaching Hospital UTH), which reached alarmingly high levels of 60 per cent in 2015.
And sources at UTH have admitted to the increasing numbers of baby deaths at the NICU and acknowledge that Sepsis remains a pressing concern.
In a report titled “Preventing Bloodstream Infections and Death in Zambian Neonates: Impact of a Low-cost Infection Control Bundle”, it was revealed that in July, 2015, the death rate at the NICU reached 60 per cent and reduced to 35 per cent in January, 2017, after the bundle was implemented.
The bundle included interventions, such as staff education, hand hygiene and environmental cleaning as well as the introduction of a low-cost alcohol hand-rub, which was produced locally by the hospital pharmacist using inexpensive reagents.
The report stated that future studies were needed to dissect whether more financially and labour-intense interventions (such as CHG bathing) are necessary to achieve maximal benefit.
Half of the enrolled neonates (50.4 per cent) experienced one or more episodes of suspected sepsis. The monthly rate of suspected sepsis was lower in the intervention than baseline period. Similarly, incidence density rates for suspected sepsis were lower during the intervention than baseline period for all birth weight categories except babies weighing less than one kilogramme.
In an interview, Dr Mwananyanda, who was lead researcher on the project, revealed that deaths at the NICU (commonly known as ‘D Block’) had reached a peak of 60 per cent during their study at the institution, a situation he described as alarming.
“As you have seen in the article, there are times when mortality, during the study period, was 60 per cent of children dying in the NICU so there are some things that can be done to reduce the high mortality. For instance, just the availability of running water, sometimes the hospital has no clean running water and then you have to have sufficient equipment, which is also a challenge in UTH; equipment like Suction machines. Secondly, the place was meant to for a certain population and the city has grown exponentially over the years, there are somewhere around 90 beds or less and the place gets overcrowded, and overcrowding itself is a vehicle for passing infection from one child to another. You see, if you are talking about a ward of 90 beds, then you are talking about 90 parents so just the children and the parents, the place has 180 people, plus you have the nurses and the doctors and others so the place is just overcrowded,” Dr Mwananyanda said.
“It’s very stressful! I remember when we were doing this study, there was one day that 14 babies died! I call it the ‘Black Thursday.’ Now, can you imagine, you are a nurse; you are a doctor and you go to sleep in the night, you are thinking ‘why I should go to work tomorrow?’ And we are not talking about a rural hospital or somewhere where there is no expertise, we are talking about the UTH! So, it is very de-motivating and demoralizing for staff that work there, it’s also not good for training, I am lucky I trained abroad, I never saw people dying in hospitals, certainly not the numbers that we see here. Now, if you have 14 babies die, next day six babies die, it’s really bad!”
He lamented that a health institution was a place to get help and not get infections as it had the potential to reverse government’s gains in the provision of decent healthcare.
“This is sad because what the government has been trying to do is encourage women to deliver at hospitals. Now, if people deliver at hospitals and the children start dying at hospitals, then you will reverse the gains you have made and maternal mortality is going to go up again and word quickly goes out so people will start thinking, ‘why should I go to UTH and deliver from there?’ But it is important because there are complications at times. So, we have to be careful not to reverse the gains that we have attained,” Dr Mwananyanda added.
“In the research, we had resources to support the research; once the research was complete, recommendations were made; publications have been done. I don’t think action has been taken. There is one time we went and presented this data at the Ministry of Health and they bought 18 Suction machines and nobody knows how they bought these machines because they started breaking down within the first two weeks! There was no service contract on them and the situation went back to what it was.”
He noted that there was need for increased resource allocation to the health sector to improve service delivery and reduce the patient-nurse ratio, which currently stands at a staggering 20:1.
“Now, another thing that is coming with too many infections is we have seen a lot of resistant bacteria, the way you treat infections is by prescribing antibiotics. So, we are seeing drug resistance to first line antibiotics, which are cheaper. Now, we are a poor country and we cannot afford third-line antibiotics, which cost US $50 for one dose. So, the issue that we are having is that we have a lot of deaths, lots of resistance, but there are ways to prevent that. We have to provide more resources and we also have to provide a little more space for neonatal interventions. UTH is clearly getting small for the population that we have and the nurse patient ratio is very high (20 babies to one nurse). So, for instance, if a child is gasping, the instinct is to help that child from gasping without thinking too much of the instrumentation you are using is sterile. So, momentarily, you provide relief to the child, but introduce infection where 48 hours later, the fever will spike and everything,” he said.
“The issue is just funding to the health sector, generally, because even the doctors are not enough and in the UTH right now, if my knowledge serves me right, they only have one Neonatologist, just one! Neonatologist means a doctor that deals with neonatal babies from one to 28 days. So, we need structured programmes; we need a proper establishments. In the NICU, the recommended is supposed to be one-to-one; in some NICUs in developed countries, the ratio is two nurses to one baby. People are just people, because one nurse to look after 20 babies? Even if you are a ‘super mother’, can you manage? So, it’s time for the policymakers to make sure that the resource is available, clinical resource to ensure doctors and nurses to do their jobs; the lab resource is available to do the works that are needed, and the pharmaceutical resource is needed. There is no rocket science here; everything is there, we just need to get our priorities right.”
And sources at UTH admitted to deaths at the NICU, saying that Sepsis remained a major concern.
They, however, stressed that it had been brought under control since 2015.
“These were measures because where they keep them (the neonates) these children are easily exposed to infections. There immune system is still building up and then they have different problems when they go there (D Block). So, when in there, the environment has to be looked at, how are they keeping the floors? Are the people working in the ward washing their hands before (touching the babies); are they following aseptic (disinfection) techniques as they are attending to these children? That’s where the challenge comes in. Those children are fed, cups they use to feed them, what’s happening? Also, back at the place of delivery, how was the delivery? Was there any chance that the baby could have gotten an infection? Then the umbilical cord, they do not do cord care where they are supposed to do it. It’s like the way they clean wounds, if it’s not properly taken care of, it will breed infection and when it gets infected, the baby will get sepsis. So, most of these children get sepsis from the umbilical cord. They don’t clean the machines in the ward as often as they should, the Suction machines; the incubators because these children (from) anything, they will get an infection. For example, look at the hydrocephalus babies, premature babies, these are at risk of anything; you sneeze around a premature baby and they get whatever (sickness) you have,” revealed the source.
“So, it’s all these small things that cause all these deaths. The deaths are there, but I think they are being controlled now. Yes, they do get sepsis, but they are treated and some do recover even though some die. The number of deaths isn’t as high as it was; we are really trying to reduce the amount of neonatal sepsis at the Hospital (UTH).”