Key message-“Effective scale up of neonatal resuscitation care in 12 hospitals of Nepal over 18 months period has led to 21% reduction in intrapartum related mortality (intrapartum stillbirth and first day mortality).”
Globally, every year 1.2 million stillbirth take place during labour and 1 million die during the first day of life. Ninety-nine percent of these deaths are found in Sub-Saharan Africa and South Asia. In Nepal, every year, 6,000 stillbirths occur during labour and 6,500 babies die during the first day of birth. Two thirds of these deaths are due to poor quality of care during birth. In 2018, more than 60% of the women in Nepal give birth at health institutions, however, the quality of intrapartum care has been poor. Improvement in quality of care requires implementation of a set of quality improvement initiatives.
A tertiary hospital study in Nepal in 2012-13 showed that implementation of quality improvement package for neonatal resuscitation reduced intrapartum stillbirth and first day mortality by almost 50%. The work led by researchers at Uppsala University, Sweden and Ministry of Health in Nepal was published in Pediatrics, the official journal of American Academy of Pediatrics in 2017.
The researchers together with Ministry of Health officials evaluated the scale up the quality improvement intervention package in 12 public hospitals across Nepal in 2017-18. After implementation of the project for 18 months, covering stepped wedge manner in 90,000 births, the evaluation showed a 21% reduction in intrapartum related mortality (intrapartum stillbirth and first day mortality) reduced by 21%. This research work has been published by KC et al and colleagues from Uppsala University in a Prestigious US medical journal-PLOS Medicine on 9 September 2019. https://doi.org/
10.1371/journal.pmed.1002900.
Key lessons from the study
- If health institution leaders engaged in implementing quality improvement processes and make it a common vision to implement change, improvements in survival can take place.
- Coupled with improved governance for care, introducing quality improvement processes such as facilitated Plan-Do-Study-Act (PDSA) cycles will help implement change at the clinical units.
- The quality metric system on key neonatal care established in each labour unit will be an accountability trigger for better governance of care.
This is the first ever large-scale evaluation done on neonatal resuscitation using a cluster randomized controlled design.
Sustainable Development Goal for 2030 aims at reducing preventable neonatal mortality to 12 per 1,000 live births. With less than 12 years for 2030 targets, further roll out of the learning from the research will keep the momentum of reducing intrapartum stillbirth and neonatal mortality in middle- and low-income settings, where most deaths take place.
For further information contact
Principal investigator-Ashish KC, , Researcher, Uppsala University. ashish.k.c@kbh.uu.se
Principal advisor-Mats Målqvist, Professor, Uppsala University. mats.malqvist@kbh.uu.se
Media contact-Srijana Sharma, advocacy specialist, Golden Community, Lalitpur, Nepal,srijanasharma1@gmail.com
