Fighting child mortality in Uganda

Every year, in low- and middle-income countries, as many as 6 million children die before their 5th birthday. In addition, 300 000 mothers also die.

“Most of these mothers and children die from diseases, which are usually easy to cure and can be prevented by simple means in the rich parts of the world,” says Professor Victoria Nankabirwa, at Makerere University (MU) and University of Bergen (UiB). She is currently leading two projects at Centre for Intervention Science in Child and Maternal Health (CISMAC). The centre is a Norwegian Centre of Excellence (SFF) of The Research Council of Norway.

In the projects, she is testing and comparing non-complex interventions, with the aim of reducing child mortality in Uganda. The results may have impacts globally.

Cleansing the umbilical cord at health facilities

In one the projects, Nankabirwa is testing the use of the antiseptic Chlorhexidine for cleaning newborn umbilical cords. As many as 98 per cent of the 3 million yearly deaths within the first 28 days of a child´s life occur in low- and middle-income countries.

“A third of these deaths are related to various infections, and infection of the umbilical cord accounts for a large part of these,” Nankabirwa explains.

A newborn´s umbilical cord being washed with Chlorhexidine.

Photo:

Kim E. Andreassen

Entrance for infection

After the umbilical cord is cut after birth, the remaining cord stump dries up and falls off within 5 to 15 days. In this period, however, the stump is dead tissue and acts as an easy entry point for microorganisms, which may cause an infection in the child.

To avoid such infections, several interventions have been recommended. One of the most promising ones, according to Nankabirwa, is cleansing with Chlorhexidine.

The World Health Organization (WHO), recommend such cleansing of children born at home, but not for those born at health centres or hospitals. For those children, soap and water is enough.

“This advice lacks scientific proof. One of the problems is that the mother and child travel home to less hygienic condition, right after giving birth at the health station,” Nankabirwa explains.

The Chlorhexidine project conducted by Nankabirwa seeks to test the effect of using Chlorhexidine at health stations. As many as 4 760 children will participate in the project, which is partly funded through the GLOBVAC-programme of The Research Council of Norway.

 

Consultations with the mothers in the project are emphazised.

Photo:

Kim E. Andreassen

Testing BCG-vaccine and immune response

In the other CISMSAC-project, Nankabirwa is testing the BCG-vaccine´s effect on new-borns.

“Some research indicates that the BCG-vaccine has some positive side effects in addition to preventing tuberculosis. It seems it has a immune boosting effect, and can reduce infections, such as HIV-infection from mother to child” Nankabirwa says.

Photo:

Kim E. Andreassen

Biological tests are brought to the lab by a motor cycle taxi, a so-called boda boda.

Finding the optimal vaccination time

Nankabirwa and her team of researchers are trying to identify the best timing for giving the BCG-vaccine.

“A few earlier studies indicate that it could be better to wait a couple of weeks rather than giving it right after birth”, says Nankabirwa.

In the study, the participants are divided in two groups. One of the new-born groups receive BCG-vaccine within 24 hour after birth, and the other group is given the vaccine after 14 weeks.

As many as 2200 newborn babies participates in the project, which is being conducted at three different health facilities in Uganda.

Photo:

Kim E. Andreassen

A big part of the project is going on in the lab.