Impact of reduced institutional delivery coverage on neonatal survival during the peak of coronavirus disease 2019 pandemic in Nepal: Estimates using Lives Saved Tool model.

BACKGROUND

An alarming observation from high-volume obstetric facilities in Nepal indicating a decreased institutional delivery rate and increased institutional neonatal mortality rate after the initial nationwide lockdown signaled the adverse population-level impact of the pandemic on the national trajectory of neonatal survival.

OBJECTIVES

We aimed to estimate the impact of change in institutional delivery coverage on cause-specific neonatal mortality during the coronavirus disease 2019 pandemic in Nepal.

DESIGN

Modeling-based study.

METHODS

We used the open-access Lives Saved Tool, based on a linear deterministic mathematical model validated for estimating cause-specific neonatal mortality in low- and middle-income countries, to estimate the number of additional neonatal lives saved and neonatal mortality rates. Using coverage change in institutional delivery rates as a proxy for interventions during childbirth, we compared the estimates using 'reported' coverage change during the pandemic with the 'targets' per Nepal Every Newborn Action Plan.

RESULTS

The projected number of additional neonatal lives saved when the pandemic hit the hardest (Nepalese fiscal year 2020-2021) when national annual institutional delivery rate reportedly decreased was lower (104; 95% confidence interval: 69-148) compared to the target scenario (222; 95% confidence interval: 152-313). However, in the next year 2021-2022 when the institutional delivery rate increased, the number was higher (926; 95% confidence interval: 643-1295) compared to target scenario (329; 95% confidence interval: 226-466). The trajectory of the projected neonatal mortality rate per 1000 live births reversed (increased to 20.18) in 2020-2021 compared to 20.11 in 2019-2020 and then tracked down to 18.75 in 2021-2022. Most newborn lives would be saved from asphyxia, sepsis, and prematurity-related complications. Neonatal resuscitation, thermal protection, and cord care are the top three lifesaving interventions during childbirth.

CONCLUSION

Neonatal survival in Nepal was adversely impacted during the peak of the coronavirus disease 2019 pandemic, with a favorable bounce back next year, based on the Lives Saved Tool projection per change in institutional delivery coverage.