On January 9, a baby girl arrived much earlier than expected. Born at just 26 weeks of pregnancy at Moroto Regional Referral Hospital, she weighed only 700 grammes. Her condition was critical, requiring immediate resuscitation moments after birth before being transferred to the neonatal intensive care unit (NICU).
Her mother was filled with fear. ‘From the moment Serendipity was born, I thought she would not survive,’ she recalls.
Ninety-five days later, the baby left the hospital weighing 1.6 kilogrammes, breathing on her own and feeding well. Today, she is thriving at home.
Her survival was made possible by Dr Tom Ediamu, a neonatologist at Moroto Regional Referral Hospital and a graduate of the Seed Global Health Neonatology Fellowship programme. For him, this case represents more than just a clinical success; it highlights the possibilities that specialised newborn care can bring to Uganda’s most underserved regions.
However, it also underscores a persistent national challenge; the shortage of specialists trained to care for critically ill newborns.
Uganda’s newborn crisis
Uganda continues to face high neonatal mortality, despite progress in maternal and child health. According to the Uganda Demographic and Health Survey 2022, the country records 22 neonatal deaths per 1,000 live births, meaning about one in every 45 babies dies before reaching one month of age.
Recent estimates suggest approximately 32,000 newborn deaths occur annually. Many are linked to prematurity, birth asphyxia, infections and complications of low birth weight, conditions that are often preventable or treatable with timely specialist care.
However, access to such care remains limited, particularly outside urban centres. Neonatologists are few, and many district and regional hospitals operate without specialised newborn expertise.
For families in remote regions such as Karamoja, survival often depends on distance, timing and the availability of trained personnel, factors that frequently work against them.
A life built in medicine
Dr Ediamu has spent 30 years in medical practice. Before his current posting in Moroto, he served for 28 years at Hoima Regional Referral Hospital, where he gained extensive experience in paediatrics and newborn care.
His transfer to Moroto two years ago placed him in one of Uganda’s most resource-constrained settings, where referral delays, limited infrastructure and high-risk pregnancies are common.
His decision to pursue neonatology came from a desire to strengthen his ability to save critically ill newborns and mentor younger colleagues.
‘I was motivated to acquire additional knowledge and skills to better manage critically ill newborns requiring advanced life support, mentor junior colleagues, and contribute to improving newborn care systems,’ he says.
The fellowship training equipped him with advanced competencies rarely available in regional hospitals, including neonatal ventilation, intubation, surfactant administration and central line insertion.
‘These skills significantly improved survival among extremely premature and critically ill newborns,’ he explains.
Life on the frontline in Moroto
Working in Karamoja has exposed Dr Ediamu to the harsh realities shaping newborn survival in Uganda.
Many mothers travel long distances on foot, motorcycle or overcrowded transport to reach hospital. Some arrive late due to poverty, geographic isolation or lack of nearby health facilities.
By the time they reach care, newborns are often critically ill, having missed early stabilisation.
‘It is not uncommon to receive a newborn who has travelled for hours without adequate warmth or medical support,’ he says.
Inside the NICU, the burden of disease is heavy. Prematurity, neonatal sepsis, birth asphyxia and low birth weight dominate admissions. Many cases are complicated by limited antenatal care or home deliveries.
The unit operates under constant pressure, balancing limited resources against high demand for specialised interventions.
Saving a 700-gramme baby
Serendipity’s case illustrates both the fragility and resilience seen in the unit.
Born following a referral from Kotido General Hospital due to pre-term labour linked to a urinary tract infection, she arrived with severe respiratory distress, feeding difficulties and inability to regulate body temperature. Her condition worsened, and at one point her weight dropped from 700 grammes to 580 grammes.
‘She was critically ill and required continuous support,’ Dr Ediamu recalls.
The medical team provided respiratory support using bubble Continuous Positive Airway Pressure (CPAP), antibiotics, blood transfusions, and carefully managed nutrition using expressed breast milk and fortified feeds.
Kangaroo Mother Care was introduced early, promoting skin-to-skin contact to stabilise temperature and improve bonding. Gradually, the baby improved, gaining weight, tolerating feeds and weaning off respiratory support.
After 95 days in the NICU, she was discharged. ‘Seeing a premature baby who once struggled to breathe leave hospital with a healthy mother is a powerful reminder of why we do this work,’ Dr Ediamu says.
Systemic gaps in newborn care
Despite such successes, Dr Ediamu says Uganda’s newborn care system faces major structural challenges. There is a critical shortage of neonatologists, paediatricians and neonatal nurses, resulting in overwhelming workloads and burnout among existing staff.
Many facilities lack essential equipment such as incubators, CPAP machines, phototherapy units and reliable oxygen supply. Weak referral systems further delay access to emergency care.
Infrastructure limitations, including inconsistent electricity and medicine shortages, also affect service delivery.
Beyond the health system, social and economic factors play a major role. Poverty, limited maternal education and low awareness of newborn danger signs often delay care-seeking. In some communities, traditional beliefs continue to influence health decisions.
‘Harmful practices and delayed care-seeking contribute significantly to poor outcomes,’ he notes.
Building expertise at home
Until recently, doctors seeking advanced neonatal training had to study abroad, limiting the growth of local expertise.
The establishment of the Neonatology Fellowship programme at Makerere University in 2019 marked a turning point in strengthening Uganda’s capacity.
The programme was designed to train specialists in the care of premature and critically ill newborns within the local health system. Today, Uganda has only about 10 locally trained neonatologists serving a population of more than 45 million people and more than one million annual births.
While the number remains small, the programme is gradually decentralising expertise from Kampala to regional hospitals.
For doctors such as Dr Ediamu, this shift means being able to deliver advanced care where it is most needed.
A career defined by impact
After three decades in medicine, Dr Ediamu continues to measure success in small but powerful outcomes: newborns who survive against the odds, families reunited, and lives given a chance to begin.
His work demonstrates how specialised skills, when combined with determination and system strengthening, can transform outcomes even in resource-limited settings. For him, neonatal care is not only a medical specialty but a commitment to protecting the most vulnerable lives at their earliest and most fragile stage.
Lessons from Karamoja
Living and working in Karamoja has reshaped Dr Ediamu’s understanding of healthcare delivery.
He describes resilient communities despite drought, food insecurity and economic hardship.
Malnutrition among mothers and infants remains common, while transport barriers often delay emergency referrals.
Cultural beliefs and limited awareness of medical danger signs also influence when families seek care.
These realities have reinforced his belief that newborn survival depends on more than hospital-based interventions.
‘Healthcare extends beyond medicine. Survival is shaped by nutrition, transport systems, education and community awareness,’ he says.
The experience has also deepened his appreciation for teamwork, adaptability and community engagement in clinical care.