Background Complications of prematurity are the leading cause of deaths in children under the age of five. The predominant reason for these preterm deaths is respiratory distress syndrome (RDS). In low-income countries (LICs) there are limited treatment options for RDS. Due to their simplicity and affordability, low-cost bubble continuous positive airway pressure (bCPAP) devices have been introduced in neonatal units in LICs to treat RDS. This study is the first observational study from a LIC to compare outcomes of very-low-birth-weight (VLBW) neonates in pre- and post-CPAP periods. Methods This was a retrospective study of VLBW neonates (weight < 1500 g) in Mbale Regional Referral Hospital Neonatal Unit (MRRH-NNU), a government hospital in eastern Uganda. It aimed to measure the outcome of VLBW neonates in two distinct study periods: A 14-month period beginning at the opening of MRRH-NNU and covering the period until bCPAP was introduced (pre-bCPAP) and an 18-month period following the introduction of bCPAP (post-bCPAP). After the introduction of bCPAP, it was applied to preterm neonates with RDS when clinically indicated and if a device was available. Clinical features and outcomes of all neonates < 1500 g were compared before and after the introduction of bCPAP. Results The admission records of 377 VLBW neonates < 1500 g were obtained. One hundred fifty-eight were admitted in the pre-bCPAP period and 219 in the post-bCPAP period. The mortality rate in the pre- bCPAP period was 39.2% (62/158) compared with 26.5% (58/219, P = 0.012) in the post-bCPAP period. Overall, there was a 44% reduction in mortality (OR 0.56, 95%CI 0.36–0.86, P = 0.01). There were no differences in birthweight, sex, presence of signs of respiratory distress or apnoea between the two groups. Conclusion Specialized and resource-appropriate neonatal care, that appropriately addresses the challenges of healthcare provision in LICs, has the potential to reduce neonatal deaths. The use of a low-cost bCPAP to treat RDS in VLBW neonates resulted in a significant improvement in their survival in a neonatal unit in eastern Uganda. Since RDS is one of the leading causes of neonatal mortality, it is possible that this relatively simple and affordable intervention could have a huge impact on global neonatal mortality.

Neonatal tetanus remains a significant, yet avoidable, cause of neonatal death. Despite the 34,000 deaths that occur globally from neonatal tetanus every year, there has been little research into the management of neonatal tetanus. Until worldwide elimination of neonatal tetanus is achieved, the case management of this devastating illness needs to be improved. We describe an improved outcome of neonatal tetanus following the introduction of a neonatal tetanus protocol including diazepam, magnesium sulphate, bubble continuous positive airway pressure and broad-spectrum antibiotics in a low-resource setting in eastern Uganda.

Background: In high malaria transmission settings, there is paucity of data on the relationship between parasite density and severe malaria forms. In patients with severe malaria, we characterised parasite density for the different clinical spectra and assessed its association with mortality. Methods: This was a cross sectional study conducted as part of the Malaria Epidemiological, Pathophysiological and Intervention studies in Highly Endemic Eastern Uganda code named TMA 2016SF-1514-MEPIE Study, at Mbale Regional Referral Hospital in Eastern Uganda. Children aged 2 months to 12 years with positive P. falciparum malaria on microscopy and who fulfilled the WHO 2014 clinical surveillance criteria for severe malaria were enrolled into the study. Parasite density was determined by multiplying the parasite count acquired from microscopy by the patients WBC count (parasite count*WBC count/200) and classified as hyperparasitaemia when parasite density was 10% or > 250,000 parasites/μl. Data were analysed using Stata 15 and P-value of 0.05 at 95% confidence intervals were used to show significant associations. Results: We screened 897 children, of which 377 were eligible for recruitment with severe malaria forms according to the WHO definition. Of these, 76.9 % (290/377) presented with prostration, 55.4% (209/377) with jaundice, 48.5% (183/377) with severe anaemia, and 46.7% (176/377) with haemoglobinuria (dark or black urine). Cerebral malaria constituted 7.4% (28/377) with 64.3% of the cases among under 5 year olds, 23.1% (87/377) had impaired consciousness, 8.2% (31/377) had respiratory distress, 15.4% (58/377) had acidosis, and 13.8 % (52/377) had renal impairment. Mean parasite density was 136,000 parasites/µl (range 36- 2,791,400 parasites/ µl). The Highest parasite density was 386,000 parasites/ µl in hypovolemic shock and the lowest parasite density was 54,917 parasites/ µl in spontaneous bleeding. Over-all mortality was 3.4 % CI (1.3-5.5). Conclusions: There were low parasite densities in the patients with severe malaria in this area. The meanparasite density was 136,000 parasites/ µl. Highest parasite density was 386,000 parasites/µl in hypovolemic shock and the lowest was 54,917 parasites/µl in spontaneous bleeding. No association with mortality was found.