Only six months into her pregnancy, Rehema Kampire started having contractions that would indicate an early birth. She was devastated at the risk of losing her baby, when she gave birth to a baby girl weighing 1.3kgs instead of the normal three kilograms of a healthy nine-month-old baby.
Although there is a low likelihood of survival for babies born before 28 weeks, Melissa Isheja Igitangaza survived after being immediately placed under prenatal care and spending one and a half month in the Neonatal Intensive Care Unit (NICU) at Gisenyi Hospital.
Now, four months old and healthy, Igitangaza’s life is considered a miracle.
Kampire’s case was complicated, but not unusual. According to World Data Atlas, Rwanda had a neonatal mortality rate of 17 deaths per 1,000 live births in 2020. According to studies, the preterm birth rate is estimated to be around 10 per cent, and prematurity is the leading cause of neonatal and child mortality countrywide.
In her case, however, skilled hospital personnel were able to trace the causes of her complications, including the fact that she had previously experienced miscarriages.
"We discovered that she had also failed to take the eight mandatory pregnancy tests that expectant mothers are required to take in order to have a safe birth,” said Claudine Uwingabire, a neonatal nurse at Gisenyi Hospital.
She stated that they were able to assist Kampire and her baby because of the skills, equipment, and improved organizational structure provided by the Integrated Rwandan Perinatal Improvement Programme (RPIP).
Due to slowing progress in maternal/neonatal survival, Rwanda Paediatric Association, Royal College of Paediatrics and Child Health Global, Rwanda Biomedical Centre, and UNICEF launched a new partnership program in 2017 focused on improving new-born and maternal survival in facilities with high morbidity/mortality.
From 2019, the program expanded coverage from 12 to 19 hospitals, including 86 primary health care centres. During this time, the program coverage increased from 8,240 (2017) to 17,802 (2021) neonatal admissions and 143,438 (2021) hospital and health centre deliveries.
The program, which covers 14 districts in Rwanda, is supported by the Rwandan government and international private companies such as Takeda, a global pharmaceutical company.
"The biggest challenges were having many premature babies, mothers getting infections after giving birth, and a lack of staff skills and equipment,” said Gisenyi Hospital Director, Dr Oreste Tuganeyezu.
Out of every 100 children born each month, the hospital records four premature cases. "There is still much work to be done. No child should die at birth, and no woman should die while giving birth,” he said.
Under the program, Gisenyi Hospital’s staff was provided with adequate clinical skills and behaviour, improved perinatal conditions and adequate equipment, tips on parental and neonatal care, and overall neonatal survival.
According to Dr Emmanuel Manzi, UNICEF Health Specialist, neonatal mortality has decreased by 30 per cent from 2017 to 2022, hypothermic babies in maternity have decreased from 45 per cent to 13 per cent, and hypothermia on neonatal admission has decreased from 58 per cent to 38 per cent in the last three years.
The number of viable babies born increased from 65 per cent to 89 per cent, the frequency of new-born observations doubled from 1.7 to 3.5 times on average in 24 hours, the appropriate administration of uterotonics increased from 70 per cent to 96 per cent from 2019 to 2022, and labour monitoring increased from 13 per cent in 2019 to 95 per cent in 2022.
UNICEF urged the local private sector to invest in the Public Private Community Partnership, particularly in the establishment of second-generation health posts, which are critical in providing specialized services (maternity, dental, eye, and laboratory services) that are currently not available in existing primary health facilities in the country.