Major causes of deaths revealed

The total number of deaths reported from health facilities has reduced by six percent, from 56,878 in 2021/2022 financial year to 53,222 deaths in 2022/2023 financial year, the government has indicated.

This information is contained in the Annual Health Sector Performance report for the 2022/2023 financial year released on Wednesday.

According to the report, of the 53,222 deaths registered in facilities last financial year, the “General Hospitals registered the highest proportion of inpatient deaths, having 30.7 percent followed by the regional referral hospitals with 26.8 percent.”

The report adds: “It is worth noting that neonatal conditions (common diseases affecting newborn children such as cold, cough and fever) are now the leading cause of health facility deaths among all ages accounting for 10.3 percent, followed by malaria (7.4 percent) pneumonia (5.3 percent), anaemia (3.9 percent).”

Road traffic incidents due to motorcycles and vehicles contributed 2.3 percent of the deaths and septicemia, which is the poisoning of blood by bacteria, contributed 1.9 percent of health facility deaths.

“Despite the increase in malaria incidence from 302/1000 to 317/1000 population, and increase in malaria admissions by 16.6 percent, the number of malaria deaths reported reduced by 15 percent from 5,017 to 4,245,” the report further indicates.

Inroads

The Health ministry, in the report, attributed this to early detection and improved case management as well as Integrated Community Case Management (ICCM) for children under five. The ministry also noted that “there is no significant change in the major causes of institutional deaths over the last three financial years”, quickly adding, “however, there is notable reduction by 36.8 percent in deaths due to neonatal conditions from 5,899 in 2021/22 to 3,730 in 2022/23.”

The ministry attributed this to the focused interventions for reduction of death of newborn babies, such as those between 28 weeks of gestation onwards and before the first seven days of life (perinatal death) whose notification and review improved with the “establishment of Neonatal Intensive Care Units and mentorship programme.”

Perinatal death reviews are done to find the causes of the death and address what could have caused the death. Dr Richard Mugahi, the assistant commissioner for reproductive and infant health at the ministry, said they also do reviews for maternal deaths.

Bottlenecks

Concerning in the report is that 22,125 (close to half) of the total of 53,222 deaths in health facilities, were children under five years. Neonatal conditions, malaria, pneumonia and anaemia were the leading causes of death among the under five years.

Dr Mugahi said they are increasing efforts to reduce preventable deaths.

“We found what killed the newborns, those within 28 days, the number one killer is birth asphyxia, which is the failure of these newly born babies to breathe well,” Dr Mugahi said, adding, “It is telling us that every centre where there is delivery, we need gadgets that can resuscitate and we need to train health workers more into that package of helping babies to breathe. We have already started training our nurses how to handle the newborn.”

According to the report, in addition to birth asphyxia, complications of prematurity and septicaemia have remained the leading cause of neonatal deaths over the past five years.

The assistant commissioner said perinatal deaths stand at 18 per 1000 deliveries, adding, “our target is to get to as low as 12 (deaths) per 1,000 births by 2030 and our target for mothers is to get to as low as 70 (deaths) per 100,000 births by 2030.”

Maternal deaths

The new report put maternal deaths at 90 per 100,000 live births in health facilities, a slight increase from 85 deaths per 100,000 live births in the previous (2021/2022) financial year. There were 1,276 maternal deaths out of 1.4 million births in facilities, which is higher than 1,226 deaths registered in the 2021/2022 financial year.

“We have registered success in reducing maternal mortality [from 336 to 189 deaths per 100,000 live births]. Although at 189 per 100,000, is not acceptable. We want to see that every mother that comes into our facilities doesn’t die,” Dr Diana Atwine, the Health ministry’s permanent secretary, said, pointing to the inroads captured in the Uganda Demographic and Health Survey report released in September.

“We want to look at possible causes and how we can move forward to tackle the particular areas that need improvement. One of them is the haemorrhage. It still continues to be the leading cause of maternal deaths in our facilities. We still see many mothers coming with high blood pressure (eclampsia),” she added.

Dr Atwine also said the other causes of maternal deaths are malaria in pregnancy and infections, especially abortion in young women. Capacity building, particularly “on our responsiveness” and absenteeism, is key per the permanent secretary. As is dealing with teenage pregnancies, to which she proffers “behaviour change.”

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