Breathing New Life: How CPAP Machines Reduced Neonatal Deaths in CHUB Hospital
While neonatal deaths remain a concern in hospitals across the country, a study conducted at the University Teaching Hospital of Butare, CHUB, has shown that the use of Continuous Positive Airway Pressure (CPAP) machines has led to a decrease in child mortality rates. Premature babies require specialized care to mimic the conditions of the womb, as their immune systems are not fully developed. Upon birth, these babies must breathe on their own, as their underdeveloped lungs cannot sufficiently take in air to sustain life. Specialized machines are necessary to provide warmth and air, but unfortunately, they are not readily available in all healthcare facilities.
In the 2021-2022 study, conducted at the Centre Hospitalier Universitaire de Butare (CHUB), it was shown that in this hospital the deaths of babies less than 21 days old were reduced based on the help of CPAP machines to support premature babies. These CPAP machines were provided by the Belgian development agency, Enabel, as part of the Belgo-Rwanda cooperation programme 2019-2024 in the health sector. The neonatal death rate was 20% in the first quarter of the Financial Year 2019 but reduced to 6% in the same period in FY 2023/24.
Based on the findings of the study additional CPAP machines were procured for other hospitals. The Belgium Development Agency-Enabel-Rwanda provided a total of 52 CPAP machines and the evidence of their importance in reducing neonatal deaths resulted in other donors procuring more CPAP machines. All District Hospitals now have CPAP machines. The neonatal death rate is reduced from 8% in 2019 to 6% currently.
The Director of Research at the University Teaching Hospital of Butare, CHUB, Dr. Félicité Mukamana, emphasized that the number of neonatal deaths has decreased due to the CPAP machines provided to the hospital.
She said, “The research we conducted showed that there were many deaths of neonates. We didn’t just want to know the reason; we also wanted to do something about it.”
She added, “It has been revealed that there may be hidden factors behind the deaths of many children who did not have a proper breathing system. We were given CPAP machines; we saw the changes, and we researched these machines. We compared industrial machines with conventional ones. On average, we found that industrial machines help children breathe better than usual.”
She stressed that mothers and families of babies admitted to neonatal units often face financial and logistical challenges that need addressing for the benefit of family welfare and neonatal survival.
These were also confirmed by Yvette Mukundwa, the Director of Nursing and Midwifery activities at Kibilizi Hospital in Gisagara District, who said that this hospital used to have a lot of neonatal deaths, but after getting these machines, it decreased.
She said, “We had high neonatal mortality. In 2020, 15% of the babies admitted died, but this year it is 6%. You can feel that it has decreased a lot in the last few years.”
The Monitoring and Evaluation Adviser at Enabel in Rwanda, Hadley Mary, highlighted that 25 studies have been conducted to improve maternal, neonatal, and child health.
She said, “We were trying to see how we could improve the health of children and mothers during childbirth at this hospital. We have conducted research using internationally recognized methods; we have helped midwives and doctors conduct these studies.”
She revealed that the combination of knowledge and skills training for nurses in the neonatal intensive care unit and the availability of factory-made CPAP machines can significantly improve the chance of survival of neonates in a teaching hospital in Rwanda.
She concluded by recommending that all neonatal units should have adequate factory-made CPAP machines to cater to the number of neonatal admissions with respiratory distress.
CHUB admitted 704 neonates in 2022, one-third were referred from District Hospitals across Southern Rwanda. It has a Neonatology Unit that admits between 50 and 80 neonates each month. Of these, over 37% are premature. The mortality rate of those admitted to the award in FY 2021/22 was 18%. The survival rate for premature neonates was 31%. 64% of all deaths in the Neonatal Unit.
A lot has been done for mother-and-child health care in the seven districts supported by the Barame Project and Nationwide supported by the Enabel Results-based Financing programme, including 41 ambulances given to hospitals (with an additional 45 under procurement), 34 maternity wards with equipment to help neonates born with distress, increasing access and quality of comprehensive services offered to Gender-Based Violence (GBV) victims, renovation of health centers to increase the quality of the services they provide, etc.
At least over 25 billion Frw were invested in these various activities to improve the health of the child and the mother, as well as adolescent sexual and reproductive health in the seven districts of Gisagara, Rusizi, Nyamasheke, Karongi, Gakenke, Rulindo, and Nyarugenge, and at least 24 billion Frw were invested to improve the maternal and child health nationwide, including RFW 1.2 billion for equipment alone.
Research conducted by the World Health Organization (WHO) shows that the health of the child and mother are in great danger if the child is born prematurely. Rwanda has made great strides in reducing child mortality and many of the service utilization indicators that are associated with a reduction in child mortality.
