Children's Medical Mission, Kathmandu, Nepal.
Department of Public Health, Brigham Young University, Provo, UT, USA.
Glob Health Action. 2023 Dec 31;16(1):2289735. doi: 10.1080/16549716.2023.2289735. Epub 2023 Dec 12.
Global neonatal mortality necessitates access to immediate newborn care interventions. In Nepal, disparities persist in the readiness and availability of newborn care services within health facilities.
This study aimed to assess this status and compare facilities that had implemented an intensive newborn resuscitation capacity building and retention programme in the past five years with those that had not.
Our observational cross-sectional study involved 154 health facilities across Nepal. Through on-site inspections and maternal log reviews, we evaluated the immediate newborn care readiness and availability.
The mean immediate newborn care intervention availability score of 52.8% (SE = 21.5) and the readiness score averaged 79.6% (SE = 12.3). Encouragingly, 96% of facilities ensured newborns were dried and wrapped for warmth, and 69.9% provided newborn resuscitation. Practices such as delayed cord clamping (42.0%), skin-to-skin contact (28.6%), and early breastfeeding (63.5%) showed room for improvement. Only 16.1% of health facilities administered Vitamin K1 prophylaxis.Domain-specific scores demonstrated a high level of facility readiness in infrastructure (97.5%), medicine, equipment, and supplies (90.6%), and staff training (90.9%), but a lower score for neonatal resuscitation aids (28.8%). Disparities in readiness and availability were evident, with rural areas and the Madhesh province reporting lower scores. Variations among health facility types revealed provincial and private hospitals outperforming local-level facilities. A positive association was observed between the LDSC/SSN mentoring programme and both the readiness and availability of immediate newborn care services.
This study highlights the gap between healthcare facility readiness and the actual availability of immediate newborn care interventions in Nepal. Addressing disparities and barriers, particularly in rural areas and local-level facilities, is crucial for improving neonatal survival. The positive link between the LDSC/SSN programme and service availability and facility readiness emphasises the significance of targeted training and mentorship programmes in enhancing newborn care across Nepal.
全球新生儿死亡率需要能够立即获得新生儿护理干预措施。在尼泊尔，卫生机构中新生儿护理服务的准备情况和可及性仍然存在差异。
本研究旨在评估这种情况，并比较在过去五年中实施过强化新生儿复苏能力建设和保留计划的设施与未实施过该计划的设施。
我们的观察性横断面研究涉及尼泊尔的 154 个卫生设施。通过现场检查和孕产妇日志审查，我们评估了新生儿即时护理的准备情况和可及性。
即时新生儿护理干预措施可得性评分的平均值为 52.8%（SE=21.5），准备情况评分为 79.6%（SE=12.3）。令人鼓舞的是，96%的设施确保新生儿保暖干燥，69.9%的设施提供新生儿复苏。延迟脐带结扎（42.0%）、皮肤接触（28.6%）和早期母乳喂养（63.5%）等做法仍有改进空间。只有 16.1%的卫生设施给予维生素 K1 预防。特定领域的评分显示，基础设施（97.5%）、药品、设备和用品（90.6%）以及员工培训（90.9%）方面的设施准备程度很高，但新生儿复苏辅助工具（28.8%）方面的评分较低。准备情况和可得性方面存在差异，农村地区和马德西省的得分较低。不同类型的卫生设施之间存在差异，省级和私立医院的表现优于地方级设施。LDSC/SSN 指导计划与即时新生儿护理服务的准备情况和可得性之间存在正相关关系。
本研究突出了尼泊尔卫生保健机构的准备情况与即时新生儿护理干预措施的实际可得性之间存在差距。解决特别是在农村地区和地方级设施中存在的差距和障碍，对于提高新生儿存活率至关重要。LDSC/SSN 计划与服务可得性和设施准备情况之间的积极联系强调了在尼泊尔开展有针对性的培训和指导计划对提高新生儿护理的重要性。
