Continuum of Care (CoC) is an essential strategy to prevent maternal and child deaths where health services are arranged in a pathway throughout pregnancy, childbirth and after delivery. However, CoC is still a challenge in Nepal. This study aimed to investigate the correlates of CoC from pregnancy to the postnatal period in Nepalese women aged 15 to 49 years. Secondary analysis was performed on the data from Nepal Multiple Indicator Cluster Survey. This led to a sample size of 2086 women who had a live birth within two years preceding the survey. We constructed three outcome models and conducted multivariable logistic regression, to assess socio-economic and demographic correlates of CoC from pregnancy to childbirth to postnatal period. Overall, 41% of the women received Antenatal Care (ANC), delivery from Skilled Birth Attendant (SBA) as well as the Postnatal Care (PNC) during their most recent birth. Women from rural areas (aOR 0.25, 95%CI: 0.18, 0.36) had reduced odds of receiving CoC while women belonging to advantaged ethnic group (aOR 1.61, 95%CI: 1.18 2.19), from middle wealth status (aOR 2.56, 95%CI: 1.68, 3.91) and upper (aOR 4.50, 95%CI: 3.07, 6.59) wealth status, and women having access to media (aOR 1.76, 95%CI: 1.31, 2.37) had higher odds of receiving CoC from pregnancy to postnatal period. Having more than two births reduced the odds of CoC by 30% (aOR 0.70, 95%CI: 0.50, 0.98). These factors were also significantly associated with ANC services and the continuum from ANC to delivery SBA. The findings suggest that the majority of Nepalese women lack a continuity of care during their pregnancy and childbirth, and several socioeconomic factors affect the spectrum of CoC. Efforts to improve maternal health services utilization in a continuum require strategies that remove demand and supply barriers of health care utilization.

Enablers to seeking treatment at mobile surgical camps for women are related to the Nepalese health system, sociocultural norms and individual experiences of women. Each of these factors should be considered when conducting mobile surgical camps, if women's uptake of treatment is to be enhanced.

BackgroundOf the children born every year in Nepal, 57.4% are delivered in health facilities. Disrespect and abuse of women during maternity care are problems that can significantly impact women’s willingness to seek out life-saving maternity care. However, evidence suggests ongoing disrespectful maternity care worldwide. This study aims to identify perceived disrespect and abuse during labor and delivery among postnatal women delivering at Bheri Hospital, Nepal.MethodsA cross sectional study was conducted among 445 purposively selected women admitted in postnatal ward of Bheri Hospital, Nepal from February to March 2020. Ethical approval was obtained from Nepal Health Research Council. Informed written consent was obtained from each participant and a face-to-face interview was conducted for data collection. A semi-structured questionnaire consisting of demographic information and a pre-validated Respectful Maternity Care (RMC) tool was used. The information was then checked, coded, and entered in SPSS for descriptive and inferential analysis.ResultsIn this study, the participants perceived very high friendly care, abuse-free care and discrimination-free care but moderate timely care only. Timely care was found to be significantly associated with age, ethnicity, occupation, monthly income, gravida, type of delivery, and complications. On multinomial regression, monthly income and type of delivery were the only factors found to be significant. Those mothers who had spontaneous vaginal delivery were 2.07 times more likely to have neutral RMC, and those who earn less than twenty thousand Nepalese rupees per month were likely to perceive high timely RMC.ConclusionThis study concludes that disrespectful or abusive maternal care is not perceived among women delivering at Bheri Hospital in terms of friendly care, abuse-free care and non- discriminatory care. However, timely care is less reported. Appropriate interventions to provide timely care to delivering women must be instituted.

Intrapartum events leading to asphyxia at birth are among the leading causes of neonatal morbidity and mortality in Nepal. In response to this, the Nepal Ministry of Health and Population adopted Helping Babies Breathe (HBB) as a tool to improve neonatal resuscitation competencies. The effectiveness of HBB trainings has been well established. However, challenges remain in maintaining skills over time. Safa Sunaulo Nepal (SSN), with support from Latter-day Saint Charities (LDS Charities) designed an initiative for scaling up newborn resuscitation training and skills maintenance over time. This paper reports on the implementation of the SSN model of newborn resuscitation trainings and skill retention, and the changes in perinatal outcomes that occurred after the program. The program built capacity among facility-based trainers for the scale up and maintenance of resuscitation skills in 20 facilities in Madhesh Province, Nepal. A single external Mentor coached and assisted the facility-based trainers, provided general support, and monitored progress. Prospective outcome monitoring tracked changes in health metrics for a period of 14 months. Data was gathered on the neonatal health outcomes of 68,435 vaginal deliveries and 9,253 cesarean sections. Results indicate decreases in neonatal deaths under 24 hours of life (p<0.001), intrapartum stillbirths (p<0.001), and the number of sick newborns transferred from the maternity unit (p<0.001). During the program, facility-based trainers taught resuscitation skills to 231 medical personnel and supported ongoing skill retention. The SSN model for newborn resuscitation training and skills retention is a low-cost, evidence-based program focusing on facility-based trainers who are mentored and supported to scale-up and sustain resuscitation skills over time. Findings from the report are suggestive that the model had a substantial influence on critical neonatal outcomes. Future programs focused on improving neonatal outcomes may benefit by incorporating program elements of SSN model.

To reduce neonatal mortality attributable to intrapartum hypoxic events, Latter-days Saint Charities (LDSC) and Safa Sunaulo Nepal (SSN) implemented a neonatal resuscitation training, scale-up, and skill retention program. This article reports on the LDSC/SSN dissemination program and newborn outcomes associated with its implementation. To evaluate the program, we used a prospective cohort design to compare outcomes of birth cohorts in 87 health facilities preimplementation and postimplementation of the facility-based training. A paired T-test was used to determine whether baseline and endline values were significantly different. Resuscitation training began with trainers from 191 facilities attending Helping Babies Breathe (HBB) training-of-trainer (ToT) courses. Thereafter, 87 facilities from five provinces received active mentoring, scale-up assistance (6389 providers trained), and skill retention support. The LDSC/SSN program was associated with decreases in the number of intrapartum stillbirths in all provinces except Bagmati. Neonatal deaths within 24 hours of birth decreased significantly in Lumbini, Madhesh, and Karnali provinces. Morbidity associations, as defined by sick newborn transfers, decreased significantly in Lumbini, Gandaki, and Madhesh provinces. The LDSC/SSN model of neonatal resuscitation training, scale-up, and skill retention has the potential to significantly improve perinatal outcomes. It could potentially guide future programs in Nepal and other resource-limited settings.