Presented at the Neonatal Society 2014 Spring Meeting.
Anderson E1, Fitchett J2, Tenzing Y3, Malla BS3, Bhatta S3, Kristensen S3
1 Barts Health NHS Trust, London, UK
2 Guys and St Thomas’ NHS Trust, London, UK
3 One Heart Worldwide, NGO
Background: Nepal is a country diverse in both its landscape and people. In 2012 the estimated neonatal mortality rate was 24 per 1000 live births (1). However, anecdotally there are wide-ranging birthing practices, as well as vastly unequal access to services in rural areas, depending on landscape and population distribution. There are exceptionally few data on birthing practices and neonatal outcomes in rural Nepal, adding challenge to the task of delivering effective and appropriate interventions to improve neonatal survival. We evaluated baseline data for a Community-Based Newborn Care Program in two remote regions of Nepal – Dolpa and Baglung – in order to understand and compare birthing practices, knowledge and outcomes in those areas.
Methods: Voluntary surveys were conducted in 46 different VDC’s with women who had delivered a baby in the past 5 years. Data collected included demographics and sources of health information; practices in and knowledge of antenatal, intrapartum, neonatal and postpartum care. Project design and data collected was carried out by NGOs, One Heart Worldwide and SWAN. Data analysis was supported by The Neonatal Society, Wellbeing of Women and The Hospital Saturday Fund as part of Elizabeth Anderson’s medical elective.
Results: 470 surveys were conducted, with 358 and 111 surveys from Baglung and Dolpa respectively. Education level and number of pregnancies differed between the two regions (p=0.0004), with the majority of women in Dolpa being illiterate. 14.5% of women in Dolpa and 28.9% of women in Baglung gave birth at an equipped facility (p=0.003), with 14% of those who delivered at home in Dolpa, doing so in an animal shed or storage room. 55% of babies in Dolpa (and 28% in Baglung) were put on the floor immediately after delivery. 19.8% of women in Dolpa compared to 50.3% of women in Baglung had at least one skilled birth attendant present (p<0.0001). 13.7% of babies in Dolpa and 54.3% in Baglung were delivered using a clean delivery kit (p<0.0001). 80.8% of the umbilical cords in Dolpa were cut with non-sterile scissors, knifes or other instruments compared to 38.2% in Baglung.
99.1% women breastfed their babies and for a median time of 6 months. The most commonly sited neonatal complications in the first month were fever, difficulty in breathing, jaundice, diarrhoea and infection of the umbilicus in both regions. Knowledge of postnatal danger signs differed significantly in the two regions. 46.9% versus 6.2% of women in Dolpa and Baglung respectively did not have a postnatal check-up (p<0.0001).
Conclusion: Our findings indicate a severe lack of basic interventions that are known to improve neonatal mortality and morbidity, in two remote regions in Nepal, with the situation in Dolpa appearing significantly worse. Despite both regions being considered ‘remote’ and ‘rural’, we have shown that there is significant inequality in access to care. Although these findings cannot be extrapolated to a wider population, they are crucial to the mobilization of appropriate resources to these areas.
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1. Unicef 2012 Country Statistics. Accessed 6/3/14: http://www.unicef.org/infobycountry/nepal_nepal_statistics.html