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Cross sectional, community based study of care of newborn infants in Nepal

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7372.1063 (Published 09 November 2002) Cite this as: BMJ 2002;325:1063
  1. David Osrin, clinical research fellowa,
  2. Kirti M Tumbahangphe, senior monitoring and surveillance officerb,
  3. Dej Shrestha, senior data management officerb,
  4. Natasha Mesko, research fellowa,
  5. Bhim P Shrestha, programme managerb,
  6. Madan K Manandhar, director, centre for local governancec,
  7. Hilary Standing, research fellow, health and social change unitd,
  8. Dharma S Manandhar, directorb,
  9. Anthony M de L Costello (ipu{at}ich.ucl.ac.uk), professora
  1. a International Perinatal Care Unit, Institute of Child Health, University College London, London WC1N 1EH
  2. b Mother Infant Research Activities, GPO Box 921, Kathmandu, Nepal
  3. c Nepal Administrative Staff College, Kathmandu, Nepal
  4. d Institute of Development Studies, Falmer, Sussex BN1 9RH
  1. Correspondence to: A M de L Costello
  • Accepted 28 June 2002

Abstract

Objective: To determine home based newborn care practices in rural Nepal in order to inform strategies to improve neonatal outcome.

Design: Cross sectional, retrospective study using structured interviews.

Setting: Makwanpur district, Nepal.

Participants: 5411 married women aged 15 to 49 years who had given birth to a live baby in the past year.

Main outcome measures: Attendance at delivery, hygiene, thermal care, and early feeding practices.

Results: 4893 (90%) women gave birth at home. Attendance at delivery by skilled government health workers was low (334, 6%), as was attendance by traditional birth attendants (267, 5%). Only 461 (8%) women had used a clean home delivery kit, and about half of attendants had washed their hands. Only 3482 (64%) newborn infants had been wrapped within half an hour of birth, and 4992 (92%) had been bathed within the first hour. 99% (5362) of babies were breast fed, 91% (4939) within six hours of birth. Practices with respect to colostrum and prelacteals were not a cause for anxiety.

Conclusions: Health promotion interventions most likely to improve newborn health in this setting include increasing attendance at delivery by skilled service providers, improving information for families about basic perinatal care, promotion of clean delivery practices, early cord cutting and wrapping of the baby, and avoidance of early bathing.

What is already known on this topic

What is already known on this topic Most births in rural south Asia occur at home

Neonatal mortality has remained fairly constant in developing countries despite falling infant mortality

What this paper adds

What this paper adds Only 6% of births in rural Nepal took place in the presence of a skilled attendant

Cord cutting implements were often unclean and drying and wrapping of newborn infants was usually delayed

99% of babies were breast fed, 92% of them within six hours of birth, and colostrum was generally given

Interventions need to focus on educating women about hygiene, encouraging early wrapping, and delaying bathing of newborn babies

Footnotes

  • Funding British Government Department for International Development, Unicef Nepal, and the Division of Child and Adolescent Health, World Health Organization, Geneva.

  • Competing interests None declared.

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