Abstract:

Prematurity has continued to be a threat in neonatal care for the developed and developing countries (Reedy, 2007). Complications of premature births account for 11.1% of all neonatal live births, and for one million deaths per year (Blencowe et al, 2013). In the U.S. where many infections and other causes of neonatal death have been markedly reduced, prematurity is the leading cause of neonatal mortality at 12.4% (Grady, 2009; Kent, 2009). To avoid the 116 million deaths and 99 million survivors with disability by 2035, the number of babies whoare small for gestational age (10·4 million in south Asia and sub-Saharan Africa in 2010) must be reduced (WHO, 2014).

Prematurity is associated with significant costs in healthcare, even without considering the costs associated with the complications that occur later in life (Gilbert et al 2003). It places increased costs for the institution towards the care and to the affected families. There is a tremendous psychological impact on the mothers/care takers and health care providers due to increased workload especially in the era of understaffing. Generally, the consequences of prematurity have an impact on the general economy of the country.

Prematurely born infants face the risk of developing complications like respiratory distress syndrome, sepsis, necrotizing enterocolitis and intraventricular haemorrhage; long term complications include bronchopulmonary dysplasia and retinopathy of prematurity (Jitta and Kyadondo, 2008; Randis, 2008). Existing literature indicate that efforts to address the problem has been put on preparing health care providers in secondary management of preterm labour and care for preterm babies after birth. A midwife being key in the care of women/mothers and their new born babies, there was need to establish the knowledge and practices towards primary prevention of premature births to determine the relevant strategies that can be used to address any gaps and contribute to the reduction of premature births and neonatal deaths in Uganda.

Prevention of premature births can be accomplished through preconception counseling which offers an opportunity to identify clients (women) with high risk factors, initiate therapies like folic acid and other prenatal vitamins, vaccinations, nutritional counseling, and commencement of lifestyle modifications like cessation of smoking and alcohol intake which may improve future obstetric outcomes. Other recommendations include: early prenatal care which serves as the preconception care but also provides an opportunity for physical examination where cervical or uterine abnormalities can be identified and interventions sought early, comprehensive ultrasonography to detect other structural deformities or abnormalities of the fetus or the mother (March of Dimes, 2008).

In Uganda, premature births contribute 31% of the total neonatal deaths. Neonatal mortality rate stands at 22 per 1,000 live births (UNICEF, WHO, UN-Population Division, 2015; Li Liu et al, 2014; Wang et al, 2014), and it is the leading cause of neonatal mortality, followed by asphyxia at 27%. In one of the teaching hospitals in central Uganda, premature births accounted for 49.5% of the monthly admissions at the Neonatal Intensive Care Unit (NICU), and an average neonatal mortality of 33% per month (NICU reports for March, April, May, & June, 2010).

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