A prospective observational study of post-delivery care and neonatal body temperature, carried out at Kathmandu Maternity Hospital, was followed by a randomized controlled intervention study using three simple methods for maintaining body temperature. There were 500 infants in the initial observation study and 300 in the intervention study. In the observation study, 85% (420/495) of infants had temperatures < 36 degrees C at 2 h and nearly 50% (198/405) had temperatures < 36 degrees C at 24 h (14% were < 35 degrees C). Most of the infants who were cold at 24 h had initially become cold at the time of delivery (only seven infants had been both well dried and wrapped). In the intervention study, all infants were dried and wrapped before random assignment to one of the three methods: the "kangaroo" method, the traditional "oil massage" or a "plastic swaddler". All three were found to be equally effective. Overall, 38% (114/298) of the infants had temperatures < 36 degrees C at 2 h and 18% (41/231) at 24 h (when none was < 35 degrees C).
Hypothermia is a common problem in neonates, particularly in developing countries where it is an important contributory factor to neonatal mortality and morbidity. An evaluation of the knowledge and practices of health professionals on the thermal control of newborns was carried out in seven countries: Brazil, India, Indonesia, Kazakhstan, Mozambique, Nepal and Zimbabwe. The evaluation, conceived as a preliminary phase for a one-day training course on thermal control, involved 28 health facilities and 260 health professionals (61 doctors and 199 nurses and midwives). It included an assessment of thermal control practices carried out in each health facility by external investigators and a questionnaire on knowledge about thermoregulation administered to health professionals involved in newborn care. The findings of the evaluation were consistent across countries and showed that thermal control practices were frequently inadequate in the following areas: ensuring a warm environment at the time of delivery; initiation of breastfeeding and contact with mother, bathing; checking the baby's temperature; thermal protection of low birth weight babies, and care during transport. Knowledge on thermal control was also insufficient, especially concerning the physiology of thermoregulation and criteria for defining hypothermia. During the one-day course that followed the evaluation, participants were able to recognize the existing gaps and to identify appropriate interventions. Knowledge and practice on the thermal control of the newborn are currently insufficient. However, awareness of the importance of thermal control and basic knowledge on thermal regulation and thermal protection can be easily acquired and on this basis motivation for improving thermal control practices can be developed.
Please cite this paper as: Malla DS, Giri K, Karki C, Chaudhary P. Achieving Millennium Development Goals 4 and 5 in Nepal. BJOG 2011;118 (Suppl. 2):60–68. The under 5 child mortality rate in Nepal is on track to achieve the target of 54 per 1000 live births by 2015 compared with 158 per 1000 live births in 1991. The maternal mortality rate also looks set to drop to its target of 134 per 100, 000 live births by 2015 from 539 per 100, 000 live births in 1991. A 3‐year interim plan (2008–11) was established to provide free basic health care for all citizens and the safe delivery incentive programme has proved to help progression towards achieving Millennium Development Goals 4 and 5. The development of a policy targeting women, children and vulnerable populations in hard to reach places is a key feature. The principle of a primary healthcare approach is applied in the development and implementation of strategy plans and programmes. The focus is on ensuring that there are functioning facilities for essential obstetric care at health facilities and provision of trained personnel at delivery.
An assessment of the incubators in use at the Kathmandu Maternity Hospital neonatal unit was undertaken; this was followed by a prospective survey of neonatal temperatures on the unit. In the incubator assessment 11 studies were carried out in five incubators. Three of the thermostats in the five incubators did not work at all and those in the other two incubators were more than 3 degrees C inaccurate. All the incubator thermometers gave recordings less than the actual temperature (with a range of error: 1.3-4.4 degrees C). Six out of the 11 babies studied were hypothermic (defined as rectal temperature < 36 degrees C). In the prospective survey of temperatures a high incidence of hypothermia was found on the neonatal unit at the time of first temperature measurement (64 per cent had a rectal temperature of < 36 degrees C). A significant association between admission hypothermia and mortality was noted. Sixteen per cent (10/64) of babies admitted with temperatures < 36 degrees C died within the first week, compared to 0 (0/36) of those admitted with temperatures > or = 36 degrees C.
NJOG 2011 Nov-Dec; 6 (2): 1 DOI: http://dx.doi.org/10.3126/njog.v6i2.6746
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