773 - Essential Newborn Care in Nepal: A Situation Analysis from Achham District

Publication Number: 773.4795

Rebecca Mabee, University of Utah School of Medicine, Salt Lake City, UT, United States; Bibek Lamichhane, Global Envirotech Initiative, Asia, Kathmandu, Bagmati, Nepal; Sarah E.. Matson, University of Utah, Bountiful, UT, United States; Spencer J. Crocker, Global Envirotech Initiative, Spanish Fork, UT, United States; Brandon Tomlin, University of Minnesota, Saint Paul, MN, United States; Bernhard Fassl, Bernhard Fassl NEOMED, ROOTSTOWN, OH, United States; Allison Judkins, University of Utah School of Medicine, Salt Lake City, UT, United States

Background: Neonatal deaths in low-resource environments are among the most common preventable causes of mortality. The remote mountainous regions of Nepal report high neonatal mortality rates. This project conducted a health facility and peripartum healthcare service delivery analysis to identify opportunities for improvement in maternal and newborn care.

Objective: Evaluate birthing centers in the Achham district of Nepal according to the World Health Organization’s (WHO’s) Essential Newborn Care curriculum.

Design/Methods: The study occurred between September and December 2023 in the Achham district of Nepal. It was part of a baseline survey conducted before implementing a comprehensive maternal-child health survival program in the district. Nepal-based public health professionals conducted a peripartum survey of women who delivered within the last 3 years and a health facility survey of birthing centers. Standardized questionnaires and checklists were abstracted from Nepal government survey tools.

The WHO’s Essential Newborn Care curriculum was referenced and includes 8 elements: 1) immediate and thorough drying, 2) skin-to-skin contact, 3) delayed cord clamping, 4) early initiation of breastfeeding, 5) thermal care, 6) infection prevention through clean practices, 7) monitoring for danger signs, and 8) timely referral if needed.

Results: The survey included 530 recently delivered women, reporting 1157 pregnancies within 14 health facilities. 90% of babies were immediately and thoroughly dried after delivery, 94% had immediate skin-to-skin contact, 74% received delayed cord clamping, and 96% had early breastfeeding initiation. Babies receiving thermal care were not directly assessed, but the survey indicated that 50% of the health facilities had infant warmers available. Clean delivery practices were not directly assessed; however, the survey did indicate that 85% of facilities have soap and running water or an alcohol-based hand rub. Monitoring for danger signs and timely referral if needed were not directly assessed but can be inferred based on the presence of a trained healthcare professional, which was found at 82% of deliveries.

Conclusion(s): This analysis demonstrated areas needing improvement, including delayed cord clamping, availability of infant warmers, infection prevention, and the presence of a trained healthcare professional to monitor for danger signs and facilitate a timely referral if needed. After implementing the comprehensive maternal-child health survival program, survey administration and data analysis will be critical in identifying areas needing continued improvement.