Assessing maternal and neonatal near‐miss reviews in rural Nepal: an implementation research study to inform scale‐up

Abstract

Aim: To understand how maternal and neonatal near-miss reviews could be implemented and scaled-up in rural communities through the existing district health system in Nepal.Methods: Mixed methods with a modified time series evaluation design were used. The World Health Organization maternal and neonatal near-miss criteria used in multicountry surveys were adapted and used to define maternal and neonatal near-miss cases.Results: The World Health Organization near-miss criteria were mainly applicable at the district hospital setting, but further adaptations were needed for community-level birthing centres, as organ dysfunction and critical intervention criteria were not found appropriate. In birthing centres, disease-based criteria were applicable for maternal near-miss review, and danger and clinical sign-based and condition at birth criteria were applicable for neonatal near-miss review. Primary barriers to implementation were attrition of trained staff due to the frequent transfer of healthcare providers, and time constraints of district hospital medical doctors for case-by-case reviews as they were often busy in hospital and in their private clinics. Conclusion: Adapted maternal and neonatal near-miss review process implementation inNepal is feasible through the existing government health system. Abbreviations CEONC, Comprehensive emergency obstetric and neonatal care; DHO, District Health Office; FCHV, Female community health volunteer; FGD, Focus group discussion; FHD, Family Health Division; IDI, In-depth interview; MNC, Maternal and newborn care; MNH, Maternal and newborn health; MNNR, Maternal and neonatal near-miss review; MNR, Maternal near-miss review; MPDR, Maternal and perinatal death review; MPDSR, Maternal and perinatal death surveillance and response; QoC, Quality of care; SBA, Skilled birth attendant; TAG, Technical advisory group; WHO, World Health Organization. Key notesIn rural areas, disease-based criteria were appropriate for maternal near-miss reviews; while for neonatal near-miss reviews, the most relevant set of criteria were the danger/clinical signs and conditions at birth criteria. Attrition of trained staff due to the frequent transfers was a primary barrier. Key recommendations include exploring integration with the existing maternal and perinatal death surveillance and response system.

Near miss Neonatal: revisão integrativa

“…Estudos que analisaram os melhores conceitos e critérios para identificar o NMN concordam que apesar da definição de Silva et al (2014) ser a mais adequada (Kale et al, 2017b;França et al, 2018), outros estudos brasileiros têm sido utilizados como referência em pesquisas nacionais (Kale et al, 2017a(Kale et al, e 2017bSantos et al, 2015aSantos et al, e 2015bSILVA et al, 2017;França et al, 2018) e internacionais (Santos et al, 2015a;Nakimuli et al, 2015;Santos et al, 2015b;Ronsmans et al, 2016;Rana et al, 2018) e tem dado suporte para a discussão da temática e enriquecido esse campo do conhecimento.…”

“…Para alguns pesquisadores, o período considerado de risco para o NMN pode variar desde o nascimento até os primeiros sete dias de vida (Santos et al, 2015b;Wick, 2017;França et al, 2018;Pileggi et al, 2010;Pileggi-Castro et al, 2014;Ronsmans et al, 2016), ou do nascimento ao 27º dia de vida (Kale et al, 2017a;Santos et al, 2015a;Nakimuli et al, 2015;Santos et al, 2015b;Silva et al, 2017;Lima et al, 2018;Avenant, 2009;Say, 2010;Rana et al, 2018), ou mesmo estender até um ano de vida (Kale et al, 2017b). Outros autores tomam como referência o evento da alta hospitalar, independente da idade do bebê (Ronsmans et al, 2016).…”

“…Nesse sentido, nas últimas décadas pesquisadores têm se dedicado a validar os critérios que definem o near miss neonatal e a desenvolver uma definição abrangente do termo (Pileggi et al, 2010;Pileggi-Castro et al, 2014;Santos et al, 2015a;Santos et al, 2015b;Ronsmans et al, 2016;Kale et al, 2017a;Kale et al, 2017b;Rana et al, 2018). Além disso, estudos de revisões de literatura têm sido desenvolvidos para preencher as lacunas do conhecimento sobre o tema (Surve, Chauhan & Kulkarni, 2017;Santos et al, 2015b).…”

Implementation research for maternal, newborn and child health

“…The remaining four papers include a study in three districts of Nepal , testing a performance‐based management system to improve health worker performance related to MNCH care delivery; a study in Arghakhanchi District, Nepal , on how to implement and scale up maternal and near‐miss reviews; another study integrating labour companionship in three public hospitals in Egypt, Lebanon and Syria ; and a study using the plan–do–study–act (PDSA) cycles to develop a strategy for delivering an intervention to increase antenatal care use among clan members in Liangshan Yi Autonomous Prefecture, China .…”

The prevalence of neonatal near miss and associated factors in Nepal: A cross-sectional study

“…Exceptionally low and high NNM prevalence was recorded in Brazil, i.e., per 1,000 live births in pregnant mothers and 303 per 1,000 live births in type 1 diabetic mothers, respectively [20,25]. A population-based study conducted in Nepal applied a community-appropriate NMN definition developed by authorities and demonstrated a prevalence of 22 per 1,000 live births [26]. NNM was shown to be caused by birth asphyxia (70%), very low birth weight (17%), neonatal sepsis (10%), and prematurity (3%) [26].…”