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Källander K, Ward C, Smith H, Bhattarai R, KC A, Timsina D, Lamichhane B, Maurel A, Ram Shrestha P, Baral S, McWhorter C, LaBarre P, de Cola MA, Baker K. Usability and acceptability of an automated respiratory rate counter to assess childhood pneumonia in Nepal. Acta Paediatr 2020; 109:1207-1220. [PMID: 31762072 PMCID: PMC7318335 DOI: 10.1111/apa.15108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 01/03/2023]
Abstract
AIM Pneumonia is the leading cause of child death after the neonatal period, resulting from late care seeking and inappropriate treatment. Diagnosis involves counting respiratory rate (RR); however, RR counting remains challenging for health workers and miscounting, and misclassification of RR is common. We evaluated the usability of a new automated RR counter, the Philips Children's Respiratory Monitor (ChARM), to Female Community Health Volunteers (FCHVs), and its acceptability to FCHVs and caregivers in Nepal. METHODS A cross-sectional study was conducted in Jumla district, Nepal. About 133 FCHVs were observed between September and December 2018 when using ChARM during 517 sick child consultations, 264 after training and 253 after 2 months of routine use of ChARM. Acceptability of the ChARM was explored using semi-structured interviews. RESULTS FCHV adherence to guidelines after 2 months of using ChARM routinely was 52.8% (95% CI 46.6-58.9). The qualitative findings suggest that ChARM is acceptable to FCHVs and caregivers; however, capacity constraints such as older age and low literacy and impacted device usability were mentioned. CONCLUSION Further research on the performance, cost-effectiveness and implementation feasibility of this device is recommended, especially among low-literate CHWs.
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Affiliation(s)
- Karin Källander
- Malaria Consortium London UK
- Programme Division Health Section UNICEF New York NY USA
- Department of Public Health Sciences Karolinska Institutet Stockholm Sweden
| | | | | | | | - Ashish KC
- Health & Nutrition Section UNICEF Nepal Kathmandu Nepal
- Department of Women's and Children's Health International Maternal and Child Health (IMCH) Uppsala University Uppsala Sweden
| | | | - Bikash Lamichhane
- Department of Health Services Ministry of Health & Population Kathmandu Nepal
| | | | | | | | - Cindy McWhorter
- UNICEF Supply DivisionProduct Innovation CentreCopenhagen Denmark
| | - Paul LaBarre
- UNICEF Supply DivisionProduct Innovation CentreCopenhagen Denmark
| | | | - Kevin Baker
- Malaria Consortium London UK
- Department of Public Health Sciences Karolinska Institutet Stockholm Sweden
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Abstract
INTRODUCTION Globally, 2.6 million stillbirths occur each year. Empowering women can improve their overall reproductive health and help reduce stillbirths. Women empowerment has been defined as women's ability to make choices in economic decision-making, household and health care decision-making. In this paper, we aimed to evaluate if women's empowerment is associated with stillbirths. METHODS Data from 2016 Nepal Demographic Health Surveys (NDHS) were analysed to evaluate the association between women's empowerment and stillbirths. Equiplots were generated to assess the distribution of stillbirths by wealth quintile, place of residence and level of maternal education using data from NHDS 1996, 2001, 2006, 2011 and 2016 data. For the association of women empowerment factors and stillbirths, univariate and multivariate analyses were conducted. RESULTS A total of 88 stillbirths were reported during the survey. Univariate analysis showed age of mother, education of mother, age of husband, wealth index, head of household, decision on healthcare and decision on household purchases had significant association with stillbirths (p < 0.05). In multivariate analysis, only maternal age 35 years and above was significant (aOR 2.42; 1.22-4.80). Education of mother (aOR 1.48; 0.94-2.33), age of husband (aOR 1.54; 0.86-2.76), household head (aOR 1.51; 0.88-2.59), poor wealth index (aOR 1.62; 0.98-2.68), middle wealth index (aOR 1.37; 0.76-2.47), decision making for healthcare (aOR 1.36; 0.84-2.21) and household purchases (aOR 1.01; 0.61-1.66) had no any significant association with stillbirths. CONCLUSIONS There are various factors linked with stillbirths. It is important to track stillbirths to improve health outcomes of mothers and newborn. Further studies are necessary to analyse women empowerment factors to understand the linkages between empowerment and stillbirths.
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Affiliation(s)
| | | | | | - Shyam Sundar Budhathoki
- Golden Community, Lalitpur, Nepal
- School of Public Health and Community Medicine, B.P Koirala Institute of Health Sciences, Dharan, Nepal
| | - Naresh Pratap KC
- Golden Community, Lalitpur, Nepal
- Society of Public Health Physicians Nepal, Kathmandu, Nepal
| | | | - Ashish KC
- Department of Women’s and Children’s Health, International Maternal and Child Health, University Hospital, 751 85 Uppsala, Sweden
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Day LT, Ruysen H, Gordeev VS, Gore-Langton GR, Boggs D, Cousens S, Moxon SG, Blencowe H, Baschieri A, Rahman AE, Tahsina T, Zaman SB, Hossain T, Rahman QSU, Ameen S, El Arifeen S, KC A, Shrestha SK, KC NP, Singh D, Jha AK, Jha B, Rana N, Basnet O, Joshi E, Paudel A, Shrestha PR, Jha D, Bastola RC, Ghimire JJ, Paudel R, Salim N, Shamb D, Manji K, Shabani J, Shirima K, Mkopi N, Mrisho M, Manzi F, Jaribu J, Kija E, Assenga E, Kisenge R, Pembe A, Hanson C, Mbaruku G, Masanja H, Amouzou A, Azim T, Jackson D, Kabuteni TJ, Mathai M, Monet JP, Moran A, Ram P, Rawlins B, Sæbø JI, Serbanescu F, Vaz L, Zaka N, Lawn JE. “Every Newborn-BIRTH” protocol: observational study validating indicators for coverage and quality of maternal and newborn health care in Bangladesh, Nepal and Tanzania. J Glob Health 2019; 9:010902. [DOI: 10.7189/jogh.09.010902] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Day LT, Ruysen H, Gordeev VS, Gore-Langton GR, Boggs D, Cousens S, Moxon SG, Blencowe H, Baschieri A, Rahman AE, Tahsina T, Zaman SB, Hossain T, Rahman QSU, Ameen S, El Arifeen S, Kc A, Shrestha SK, Kc NP, Singh D, Jha AK, Jha B, Rana N, Basnet O, Joshi E, Paudel A, Shrestha PR, Jha D, Bastola RC, Ghimire JJ, Paudel R, Salim N, Shamb D, Manji K, Shabani J, Shirima K, Mkopi N, Mrisho M, Manzi F, Jaribu J, Kija E, Assenga E, Kisenge R, Pembe A, Hanson C, Mbaruku G, Masanja H, Amouzou A, Azim T, Jackson D, Kabuteni TJ, Mathai M, Monet JP, Moran A, Ram P, Rawlins B, Sæbø JI, Serbanescu F, Vaz L, Zaka N, Lawn JE. " Every Newborn-BIRTH" protocol: observational study validating indicators for coverage and quality of maternal and newborn health care in Bangladesh, Nepal and Tanzania. J Glob Health 2019. [PMID: 30863542 PMCID: PMC6406050 DOI: 10.7189/jogh.09.01902] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background To achieve Sustainable Development Goals and Universal Health Coverage, programmatic data are essential. The Every Newborn Action Plan, agreed by all United Nations member states and >80 development partners, includes an ambitious Measurement Improvement Roadmap. Quality of care at birth is prioritised by both Every Newborn and Ending Preventable Maternal Mortality strategies, hence metrics need to advance from health service contact alone, to content of care. As facility births increase, monitoring using routine facility data in DHIS2 has potential, yet validation research has mainly focussed on maternal recall surveys. The Every Newborn – Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study aims to validate selected newborn and maternal indicators for routine tracking of coverage and quality of facility-based care for use at district, national and global levels. Methods EN-BIRTH is an observational study including >20 000 facility births in three countries (Tanzania, Bangladesh and Nepal) to validate selected indicators. Direct clinical observation will be compared with facility register data and a pre-discharge maternal recall survey for indicators including: uterotonic administration, immediate newborn care, neonatal resuscitation and Kangaroo mother care. Indicators including neonatal infection management and antenatal corticosteroid administration, which cannot be easily observed, will be validated using inpatient records. Trained clinical observers in Labour/Delivery ward, Operation theatre, and Kangaroo mother care ward/areas will collect data using a tablet-based customised data capturing application. Sensitivity will be calculated for numerators of all indicators and specificity for those numerators with adequate information. Other objectives include comparison of denominator options (ie, true target population or surrogates) and quality of care analyses, especially regarding intervention timing. Barriers and enablers to routine recording and data usage will be assessed by data flow assessments, quantitative and qualitative analyses. Conclusions To our knowledge, this is the first large, multi-country study validating facility-based routine data compared to direct observation for maternal and newborn care, designed to provide evidence to inform selection of a core list of indicators recommended for inclusion in national DHIS2. Availability and use of such data are fundamental to drive progress towards ending the annual 5.5 million preventable stillbirths, maternal and newborn deaths.
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Affiliation(s)
- Louise T Day
- Joint first authors.,Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Harriet Ruysen
- Joint first authors.,Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Vladimir S Gordeev
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Georgia R Gore-Langton
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Dorothy Boggs
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Simon Cousens
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Sarah G Moxon
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Hannah Blencowe
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Angela Baschieri
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Tanvir Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (iccdr,b), Dhaka, Bangladesh
| | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Naresh P Kc
- Department of Health Services, Ministry of Health, Kathmandu, Nepal
| | - Dela Singh
- Pokhara Academy of Health Science, Pokhara Ranipauwa, Nepal
| | | | - Bijay Jha
- Nepal Health Research Council, Kathmandu, Nepal
| | - Nisha Rana
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | | | | | | | - Deepak Jha
- Department of Health Services, Ministry of Health, Kathmandu, Nepal
| | | | | | | | - Nahya Salim
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Donat Shamb
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Karim Manji
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Josephine Shabani
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Kizito Shirima
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Namala Mkopi
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Mwifadhi Mrisho
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Fatuma Manzi
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Jennie Jaribu
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Edward Kija
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Evelyne Assenga
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Rodrick Kisenge
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Andrea Pembe
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Claudia Hanson
- Public Health Sciences - Global Health - Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden
| | - Godfrey Mbaruku
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania.,Deceased 2 September 2018
| | - Honorati Masanja
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Agbessi Amouzou
- Institute for International Programs, Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tariq Azim
- MEAUSRE Evaluation, University of North Carolina, North Carolina, USA
| | - Debra Jackson
- Knowledge Management & Implementation Research Unit, Health Section, UNICEF, New York, USA
| | | | - Matthews Mathai
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Allisyn Moran
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Pavani Ram
- Office of Health, Infectious Disease and Nutrition, Bureau for Global Health, United States Agency for International Development, Washington, DC, USA
| | | | - Johan Ivar Sæbø
- Department for Informatics, University of Oslo, Oslo, Norway
| | - Florina Serbanescu
- Division of Reproductive Health, Centres for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Lara Vaz
- Save the Children, Washington, DC, USA
| | - Nabila Zaka
- Knowledge Management & Implementation Research Unit, Health Section, UNICEF, New York, USA
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene &Tropical Medicine (LSHTM), London, UK
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Lamichhane B, Khanal L, Shrestha PR, Dawson P, Singh S. Nepal Scale up Chlorhexidine as Part of Essential Newborn Care: Country Experience. J Nepal Health Res Counc 2018; 16:359-361. [PMID: 30455502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 10/30/2018] [Indexed: 06/09/2023]
Abstract
Chlorhexidine is a broad-spectrum antiseptic, effective on gram positive and gram negative bacteria as well as some viruses, having strong skin binding effect. Randomized controlled trials conducted in South Asian countries have proven that the use of chlorhexidine (4% weight/weight) for cord care can reduce neonatal mortality and prevent severe cord infections. Between 2011 and 2017, Nepal completed nationwide scale-up of the use of chlorhexidine by integrating with ongoing maternal and neonatal health programs, under the leadership of the Child Health Division. The chlorhexidine coverage and compliance study (2017) has revealed that the country has achieved 59% coverage of the intervention to date, with lowest use among home births. The strategy should be further strengthened to ensure that every newborn in need is reached with chlorhexidine. Keywords: Chlorhexidine; cord care; Nepal experience, Newborn.
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Affiliation(s)
- Bikash Lamichhane
- Child Health Division, Department of Health Service, Ministry of Health, Kathmandu, Nepal
| | - Leela Khanal
- JSI Research and Training Institute, Inc., Kathmandu, Nepal
| | - Parashu Ram Shrestha
- Child Health Division, Department of Health Service, Ministry of Health, Kathmandu, Nepal
| | - Penny Dawson
- JSI Research and Training Institute, Inc., Kathmandu, Nepal
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6
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Shrestha G, Paudel P, Shrestha PR, Jnawali SP, Jha D, Ojha TR, Lamichhane B. Free Newborn Care Services: A New Initiative in Nepal. J Nepal Health Res Counc 2018; 16:340-344. [PMID: 30455497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/30/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Nepal has made a significant progress in reducing child mortality. However, the annual rate of reduction in neonatal mortality is not satisfactory. As safeguarded by constitution of Nepal and to address neonatal mortality due to poverty and inequity, government has introduced free newborn care (FNC) package. This study aims to assess the status of FNC services in all the public hospitals. METHODS Child Health Division organized 5 workshops region-wise with the theme of newborn care services in March/April 2018 to cover all the public hospitals in the country. A template was designed comprising of duration of FNC implementation, number of newborns admitted since implementation, morbidities pattern, and number of babies served. It was circulated and all hospitals were advised to fill it and present in the review. Later, the data were compiled and analyzed. RESULTS Only 58 presentations out of 93 participated hospitals were included in this study. The total admitted cases were 8564 newborns. The common causes of admission were neonatal sepsis (44.5%) followed by asphyxia (14.29%) and hyperbilirubinemia (11.4%). A total of 1573 neonates received services of FNC package C, 3722 package B, 3081 received package A. The main challenges faced in implementation reported were lack of infrastructure and human resources to provide services and the reimbursement is not enough. CONCLUSIONS Free newborn care is a new initiative taken to reduce neonatal mortality. This package is very helpful to serve sick newborns. However, the package should be revised taking into consideration the appropriate reimbursement and extra staffs to provide this service.
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Affiliation(s)
- Gambhir Shrestha
- Child Health Division, Department of Health Services, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Prajwal Paudel
- Child Health Division, Department of Health Services, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Parashu Ram Shrestha
- Child Health Division, Department of Health Services, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Shambhu Prasad Jnawali
- Child Health Division, Department of Health Services, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Deepak Jha
- Child Health Division, Department of Health Services, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Tek Raj Ojha
- Child Health Division, Department of Health Services, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Bikash Lamichhane
- Child Health Division, Department of Health Services, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
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Shrestha G, Mulmi R, Joshi N, Shrestha PR. Prevalence of Sepsis and Possible Severe Bacterial Infection among Neonates in Nepal. J Nepal Health Res Counc 2018; 16:1-5. [PMID: 29717280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/01/2017] [Indexed: 06/08/2023]
Abstract
Nepal lacks adequate data on the prevalence of sepsis and Possible Severe Bacterial Infection (PSBI) among neonates. Thus, this systematic review was designed to estimate the prevalence of neonatal sepsis and PSBI status in Nepal. We searched PubMed and Nepal Journal Online for relevant studies on PSBI and neonatal sepsis published from 2006 to 2016. The eligibility criteria included those studies done in Nepal, evaluating the prevalence of PSBI/neonatal sepsis with denominators as the population at risk that is either total live births or total cases evaluated. Altogether, four studies met the review criteria, out of which three were hospital-based and one community-based. There is a vast difference in prevalence rate between hospital-based (2-4%) and community-based (9%) studies. Two studies used haematological scoring system and blood culture to base their diagnosis; one used signs and symptoms for PSBI while the other did not mention the diagnostic criteria. This systematic review suggests that though neonatal sepsis poses a big problem, it lacks a significant number of related studies. There is a need to conduct a nationwide survey on the prevalence of sepsis and PSBI among neonates, which will help to develop health policy.
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Affiliation(s)
- Gambhir Shrestha
- Child Health Division, Department of Health Services, Teku, Nepal
| | - Rashmi Mulmi
- School of Public Health and Community Medicine, B.P Koirala Institute of health Sciences, Dharan, Nepal
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Pradhan YV, Upreti SR, Pratap KC N, KC A, Khadka N, Syed U, Kinney MV, Adhikari RK, Shrestha PR, Thapa K, Bhandari A, Grear K, Guenther T, Wall SN. Newborn survival in Nepal: a decade of change and future implications. Health Policy Plan 2012; 27 Suppl 3:iii57-71. [DOI: 10.1093/heapol/czs052] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y V Pradhan
- Ministry of Health and Population, Kathmandu, Nepal, 2Save the Children, Kathmandu, Nepal, 3Save the Children, Washington, DC, USA, 4Save the Children, Cape Town, South Africa, 5Institute of Medicine, Kathmandu, Nepal and 6UK Department for International Development, Kathmandu, Nepal
| | - Shyam Raj Upreti
- Ministry of Health and Population, Kathmandu, Nepal, 2Save the Children, Kathmandu, Nepal, 3Save the Children, Washington, DC, USA, 4Save the Children, Cape Town, South Africa, 5Institute of Medicine, Kathmandu, Nepal and 6UK Department for International Development, Kathmandu, Nepal
| | - Naresh Pratap KC
- Ministry of Health and Population, Kathmandu, Nepal, 2Save the Children, Kathmandu, Nepal, 3Save the Children, Washington, DC, USA, 4Save the Children, Cape Town, South Africa, 5Institute of Medicine, Kathmandu, Nepal and 6UK Department for International Development, Kathmandu, Nepal
| | - Ashish KC
- Ministry of Health and Population, Kathmandu, Nepal, 2Save the Children, Kathmandu, Nepal, 3Save the Children, Washington, DC, USA, 4Save the Children, Cape Town, South Africa, 5Institute of Medicine, Kathmandu, Nepal and 6UK Department for International Development, Kathmandu, Nepal
| | - Neena Khadka
- Ministry of Health and Population, Kathmandu, Nepal, 2Save the Children, Kathmandu, Nepal, 3Save the Children, Washington, DC, USA, 4Save the Children, Cape Town, South Africa, 5Institute of Medicine, Kathmandu, Nepal and 6UK Department for International Development, Kathmandu, Nepal
| | - Uzma Syed
- Ministry of Health and Population, Kathmandu, Nepal, 2Save the Children, Kathmandu, Nepal, 3Save the Children, Washington, DC, USA, 4Save the Children, Cape Town, South Africa, 5Institute of Medicine, Kathmandu, Nepal and 6UK Department for International Development, Kathmandu, Nepal
| | - Mary V Kinney
- Ministry of Health and Population, Kathmandu, Nepal, 2Save the Children, Kathmandu, Nepal, 3Save the Children, Washington, DC, USA, 4Save the Children, Cape Town, South Africa, 5Institute of Medicine, Kathmandu, Nepal and 6UK Department for International Development, Kathmandu, Nepal
| | - Ramesh Kant Adhikari
- Ministry of Health and Population, Kathmandu, Nepal, 2Save the Children, Kathmandu, Nepal, 3Save the Children, Washington, DC, USA, 4Save the Children, Cape Town, South Africa, 5Institute of Medicine, Kathmandu, Nepal and 6UK Department for International Development, Kathmandu, Nepal
| | - Parashu Ram Shrestha
- Ministry of Health and Population, Kathmandu, Nepal, 2Save the Children, Kathmandu, Nepal, 3Save the Children, Washington, DC, USA, 4Save the Children, Cape Town, South Africa, 5Institute of Medicine, Kathmandu, Nepal and 6UK Department for International Development, Kathmandu, Nepal
| | - Kusum Thapa
- Ministry of Health and Population, Kathmandu, Nepal, 2Save the Children, Kathmandu, Nepal, 3Save the Children, Washington, DC, USA, 4Save the Children, Cape Town, South Africa, 5Institute of Medicine, Kathmandu, Nepal and 6UK Department for International Development, Kathmandu, Nepal
| | - Amit Bhandari
- Ministry of Health and Population, Kathmandu, Nepal, 2Save the Children, Kathmandu, Nepal, 3Save the Children, Washington, DC, USA, 4Save the Children, Cape Town, South Africa, 5Institute of Medicine, Kathmandu, Nepal and 6UK Department for International Development, Kathmandu, Nepal
| | - Kristina Grear
- Ministry of Health and Population, Kathmandu, Nepal, 2Save the Children, Kathmandu, Nepal, 3Save the Children, Washington, DC, USA, 4Save the Children, Cape Town, South Africa, 5Institute of Medicine, Kathmandu, Nepal and 6UK Department for International Development, Kathmandu, Nepal
| | - Tanya Guenther
- Ministry of Health and Population, Kathmandu, Nepal, 2Save the Children, Kathmandu, Nepal, 3Save the Children, Washington, DC, USA, 4Save the Children, Cape Town, South Africa, 5Institute of Medicine, Kathmandu, Nepal and 6UK Department for International Development, Kathmandu, Nepal
| | - Stephen N Wall
- Ministry of Health and Population, Kathmandu, Nepal, 2Save the Children, Kathmandu, Nepal, 3Save the Children, Washington, DC, USA, 4Save the Children, Cape Town, South Africa, 5Institute of Medicine, Kathmandu, Nepal and 6UK Department for International Development, Kathmandu, Nepal
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Houston R, Acharya B, Poudel D, Pradhan S, Singh S, Manandhar M, Pokharel RK, Shrestha PR. Early initiation of community-based programmes in Nepal: a historic reflection. J Nepal Health Res Counc 2012; 10:82-87. [PMID: 23034367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Community-based programmes have long been an integral part of Nepal's health sector strategy and has contributed to the progress seen in maternal and child health. This paper reviews three early community-based programmes - the acute respiratory infection programme and its evolution to the fully scaled-up community-based integrated management of childhood illness programme, the national vitamin A programme and the female community health volunteer programme - and how the Government of Nepal rapidly accepted them to address pressing maternal and child health issues in an evidence-informed manner, moving rapidly from research to feasibility studies, to implementation and scale-up.
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Affiliation(s)
- R Houston
- Nepal Family Health Program II, Oasis Complex, PO Box 1600, Kathmandu, Nepal.
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Pradhan YV, Upreti SR, Kc NP, Thapa K, Shrestha PR, Shedain PR, Dhakwa JR, Aryal DR, Aryal S, Paudel DC, Paudel D, Khanal S, Bhandari A, Kc A. Fitting Community Based Newborn Care Package into the health systems of Nepal. J Nepal Health Res Counc 2011; 9:119-128. [PMID: 22929840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Community-based strategies for delivering effective newborn interventions are an essential step to avert newborn death, in settings where the health facilities are unable to effectively deliver the interventions and reach their population. Effective implementation of community-based interventions as a large scale program and within the existing health system depends on the appropriate design and planning, monitoring and support systems. This article provides an overview of implementation design of Community-Based Newborn Care Package (CB-NCP) program, its setup within the health system, and early results of the implementation from one of the pilot districts. The evaluation of CB-NCP in one of the pilot districts shows significant improvement in antenatal, intrapartum and post natal care. The implementation design of the CB-NCP has six different health system management functions: i) district planning and orientation, ii) training/human resource development, iii) monitoring and evaluation, iv) logistics and supply chain management, v) communication strategy, and vi) pay for performance. The CB-NCP program embraced the existing system of monitoring with some additional components for the pilot phase to test implementation feasibility, and aligns with existing safe motherhood and child health programs. Though CB-NCP interventions are proven independently in different local and global contexts, they are piloted in 10 districts as a "package" within the national health system settings of Nepal.
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Affiliation(s)
- Y V Pradhan
- Department of Health Service, Ministry of Health and Population, Government of Nepal
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Abstract
Abdomen is a Pandora's Box. During our routine patient evaluation we come across different types of abdominal lumps out of which some are straight forward and diagnosed after routine clinical examinations and available investigations. At times these abdominal lumps present differently from their usual presentations and create confusions despite undergoing necessary investigations. The truth is explored only after opening the Pandora's Box. We present a case of 21 years old male who presented with history of gradually increasing right sided upper abdominal lump of three years duration. He was thoroughly investigated with USG and CT scan abdomen along with other supportive investigations and was diagnosed to have Hydatid cyst of liver. Accordingly patient was prepared for surgery and it was only at the time of laparotomy that he was found to have right sided giant hydronephrosis with a nonviable renal parenchymal tissue. He underwent right sided nephrectomy and had a good postoperative recovery. So at times the abdominal lumps keep on creating diagnostic dilemmas.Key words: abdominal lump, giant hydronephrosis
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