The 13 UN Life-saving Commodities for Maternal, Newborn and Child Health: Knowledge, Attitudes and Practices in Uganda

Background: Life Saving Commodities (LSC) are medicines, medical devices and health supplies that effectively address leading avoidable causes of death during pregnancy, childbirth and childhood. In 2012 the United Nations put priority on globally promoting 13 priority LSC across the reproductive, maternal, newborn and child health (RMNCH) continuum of care. We assessed barriers to demand, access and utilization of these 13 LSC.
Methods: This was a mixed methods cross-sectional study using both quantitative and qualitative approaches. The quantitative component was a health facility survey while the qualitative one was community-based. A blend of simple random and purposive sampling was undertaken to recruit study participants in four regions of Uganda. A total of 125 health facilities were surveyed and 513 people interviewed. Descriptive and bivariate analysis was done for quantitative data while the qualitative strand employed thematic analysis. This paper presents descriptive findings on knowledge, attitudes and practices (KAP) pertaining to the 13 LSC.
Results: There was a variation in knowledge of LSC. Knowledge on child health commodities (ORS and Zinc) was higher among community members compared to the other commodities which are largely hospital-based (injectable antibiotics, antenatal corticosteroids, chlorhexidine, oxytocin, misoprostol and magnesium sulphate). Although health workers were knowledgeable on most LSC they also demonstrated limited comprehensive knowledge some, particularly those relating to reproductive and newborn health (48% and 42.4% respectively). For instance only 37.6% had comprehensive knowledge on management of preterm labour; only 44.8% health facilities had health workers knowledgeable on use of antenatal corticosteroids for preterm labour and only 30.4% reported to give antibiotics. Perceptions on some commodities, particularly the female condom and emergency contraception, were largely negative and health workers practiced selective recommendation or use. Explanatory factors for this could be traced at individual, household, community, facility and macro levels. Constrained by system-related issues like medicine stock-outs, majority of health workers were improvising and using available alternatives to LSC.
Conclusion: The concept “lifesaving commodities” for maternal, newborn and child health was not well understood by both health workers as caregivers and community as service users. As a result they have not been demanded for, made available or utilized as originally intended. Alongside improved LSC availability, their overlooked, complementary nature and efficacy should continuously be emphasized to the various stakeholders for optimum results.