UNEST - The Uganda Newborn Study
It is now well established that many low income countries will not achieve MDG 4 to reduce under-five mortality by two thirds unless neonatal mortality is well addressed. With evidence that integrating community health workers (CHWs) in health systems can lead to improved morbidity and mortality, many countries in Sub-Saharan Africa are scaling-up such programs. However, one of the challenges is how to integrate these CHWs in existing health system programs.
To adapt, develop and cost an integrated maternal-newborn care package that links community and facility care, and will evaluate its effect on maternal and neonatal practices in order to inform policy and scale-up in Uganda.
UNEST is a community randomized controlled trial in Iganga/Mayuge Health Demographic Surveillance Site in eastern Uganda. Trained CHWs make 2 pregnancy and 3 postnatal visits in the first week after birth. In addition, basic health facility strengthening is done to make supply-side care better.
Preliminary evaluations show marked improvements in key care practices such as birth preparedness, supervised deliveries, and neonatal care practices. In addition, the project has already had policy impact by contributing to the design of the country-wide community health work strategy. Furthermore, it has been used as a platform for funding of two new large scale projects: MANEST or maternal and newborn study in Uganda to be funded by DFID and WHO, and EQUIP or Expanded Quality Improvement Using Information Power to improve maternal and newborn health in Uganda and Tanzania.