Saving Uganda’s Newborn Lives through improving access to safe Water, Sanitation and Hygiene

As we join the rest of the world to mark the International Water Day, WaterAid launches a new campaign “Healthy Start” that aims at profiling the impact of lack of safe water and sanitation on new-borns and children health in Uganda.

Healthy Start: the first month of life – a WaterAid briefing – show that annually nearly half a million babies die in the first month of life because they are born into unhygienic conditions. In Uganda 6,800 new born babies died from sepsis, tetanus and other infections linked to dirty water and lack of hygiene in 2013 alone.

The campaign launches as a World Health Organization report reveals that nearly half of hospitals and clinics in Africa do not have access to clean water. And of the 58% of healthcare facilities that have some access, only half are able to count on a safe and reliable supply of clean water.

The World Health Organization report “Water, sanitation and hygiene in health care facilities: status in low and middle income countries and way forward” shows that across 18 countries in Sub-Saharan Africa, access to water in healthcare facilities is as low as 20%. In Uganda over one in three (34%) hospitals and clinics did not have access to clean water.
Across Africa one in 20 (5%) did not have safe toilets and one in ten (11%) did not have anywhere to wash hands with soap. Over a third (35%) of hospitals and clinics did not have anywhere for staff or patients to wash their hands with soap.

Uganda’s child survival strategy that was developed by the government and partners with an aim to curtail new-born deaths through cost-effective interventions and delivery mechanisms heavily focuses on treatment of diseases rather than prevention hence the less emphasis on water, sanitation and hygiene (WASH) yet it is a central tenet that could prevent the deaths and save the treatment costs

The health sector in Uganda heavily relies on treatment of diseases rather than prevention, and yet primary health care to which WASH is the key component has been less prioritised both in policy, strategies and action plans. The less prioritisation is evidenced by lack of a directorate for environmental health which therefore implies resources (financial and technical). The consequence of this is failure to address environmental health issues hence holding back progress on reducing child ill-health of which evidence is also not systematically gathered or used to inform health programmes.

WASH-related
new-born deaths
In 2013, 2.8 million new-borns (aged 0–28 days) died globally. Almost all deaths occurred in low-resourced settings and could have been prevented; 99% of new-born deaths occur in low and middle-income countries.

Deaths caused by infection which account for nearly half of all deaths in
Saving Uganda’s Newborn Lives through improving access to safe Water, Sanitation and Hygiene
WaterAid is calling for a dedicated goal to deliver water and sanitation to everyone, everywhere by 2030, including in all healthcare facilities

new-borns aged 7–28 days and 14% of new-borns aged 0–7 days are intimately linked to the environmental conditions in which babies are born. A clean environment and access to clean water are essential to reducing new-borns’ risk of infection as shown by the severe infections circle in the chart.

Sepsis (inflammation caused mainly by bacteria) is the leading cause of infection in newborns and is long-associated with poor hygiene at birth.

Research has found that ‘clean birth practices’ including handwashing with soap in homes and facilities were associated with reduced all-cause, sepsis and tetanus newborn deaths.

A study in Nepal found that birth attendant and maternal handwashing protected against neonatal mortality, with 41% lower mortality among newborns exposed to both practices.

While the number of newborn deaths globally is falling, it could be significantly reduced if more attention were given to creating clean birthing environments, and to the water, sanitation and good hygiene practices needed for this.

Water, sanitation and hygiene to protect
newborn health
In order to adequately protect newborns from risks of infection, the World Health Organization (WHO) advocates the practice of ‘six cleans’ during delivery and post-natal care.

Clean hands (of birthing attendants and postnatal careers), Clean perineum, Clean delivery surface, Clean umbilical cord cutting, Clean umbilical cord tying and Clean umbilical cord care

In addition to these it is important to maintain general cleanliness of newborns by washing before, and after, feeding and defecation. All of the above rely on:

Water – access to and use of water that is free from contamination by pathogens and chemicals. This requires convenient and consistent access to sufficient quantities of safe water.
Sanitation – safe disposal of wastes from delivery (i.e. placental waste and medical wastes) and continued safe disposal of newborn excreta.

Hygiene – access to and use of adequate disinfecting materials (i.e. soap and detergents) for achieving hygienic conditions (i.e. for hand-washing, body washing, cleaning surfaces and instruments, laundering sheets etc.)

Our Call to Government
and Stakeholders;
Every healthcare facility has clean running water, safe toilets for patients (separate for men and women, child-friendly, accessible to people with disabilities, and complete with locks and lights), functional sinks and soap for health workers and patients in all treatment and birthing rooms.

No new healthcare facilities are built without adequate, sustainable safe water and sanitation services. This should be spelt out clearly in the Public Health Act currently under review.

Uganda’s healthcare system/ministry should commit to including good hygiene practice and promotion in professional training, plans and actions. Staff and mothers are informed and empowered to practice adequate hygiene measures.

Every birthing centre ensures basic hygiene and sterile conditions, particularly in delivery rooms and operating theatres – such as hand-washing with soap, repeated cleaning and disinfection of facilities, and safe separation of human and medical waste from human contact.

Women giving birth away from maternity clinics must have access to clean water, a clean birthing area and a trained birth attendant who practices safe hygiene.

The government, development partners and stakeholders in newborn health should ensure that water, sanitation and hygiene services (WASH) are integrated in all plans for reducing newborn deaths, Standards for Maternal and Neonatal care and across the health systems plans that encompass any or all of these objectives. Government should ensure finances are made available and used accordingly.

Monitoring and assessment of progress towards universal health coverage include data on the availability of water, sanitation and hygiene services at healthcare facilities and household levels to inform strategies and planning.

The Sustainable Development Goals should include a dedicated goal for Water and Sanitation with ambitious targets for universal WASH access by 2030. The framework should ensure integration between WASH targets and health targets such as universal health coverage and prevention of under-five and maternal mortality.

Investing in water in health facilities and clinics will help Uganda realize better health outcomes. Together we can end the needless and preventable deaths of new-borns through prioritizing Water, Sanitation and Hygiene.