Mistreatment of newborns after childbirth in health facilities in Nepal: Results from a prospective cohort observational study

Ashish, K C; Moinuddin, Mohammed; Kinney, Mary V.; Sacks, Emma; Gurung, Rejina; Sunny, Avinash K; Bhattarai, Pratiksha; Sharma, Srijana

doi:10.1371/journal.pone.0246352

Cited by 6 publications

(2 citation statements)

References 25 publications

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“…Similarly, the coverage of skin-to-skin contact remained relatively low, despite government prioritisation of this intervention [ 21 ]. The finding is consistent with an observational study of four referral level public hospitals in Nepal which found that skin-to-skin contact was practiced in only 3.50% of babies who breathed spontaneously after birth [ 22 ]. The lack of trained and motivated healthcare staff, along with logistical challenges affects its availability [ 23 ].…”

Section: Discussionsupporting

confidence: 90%

An assessment of immediate newborn care readiness and availability in Nepal

Dhungana,

Chalise,

Clark

2023

Global Health Action

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Background Global neonatal mortality necessitates access to immediate newborn care interventions. In Nepal, disparities persist in the readiness and availability of newborn care services within health facilities. Objective This study aimed to assess this status and compare facilities that had implemented an intensive newborn resuscitation capacity building and retention programme in the past five years with those that had not. Methods Our observational cross-sectional study involved 154 health facilities across Nepal. Through on-site inspections and maternal log reviews, we evaluated the immediate newborn care readiness and availability. Results The mean immediate newborn care intervention availability score of 52.8% (SE = 21.5) and the readiness score averaged 79.6% (SE = 12.3). Encouragingly, 96% of facilities ensured newborns were dried and wrapped for warmth, and 69.9% provided newborn resuscitation. Practices such as delayed cord clamping (42.0%), skin-to-skin contact (28.6%), and early breastfeeding (63.5%) showed room for improvement. Only 16.1% of health facilities administered Vitamin K1 prophylaxis.Domain-specific scores demonstrated a high level of facility readiness in infrastructure (97.5%), medicine, equipment, and supplies (90.6%), and staff training (90.9%), but a lower score for neonatal resuscitation aids (28.8%). Disparities in readiness and availability were evident, with rural areas and the Madhesh province reporting lower scores. Variations among health facility types revealed provincial and private hospitals outperforming local-level facilities. A positive association was observed between the LDSC/SSN mentoring programme and both the readiness and availability of immediate newborn care services. Conclusion This study highlights the gap between healthcare facility readiness and the actual availability of immediate newborn care interventions in Nepal. Addressing disparities and barriers, particularly in rural areas and local-level facilities, is crucial for improving neonatal survival. The positive link between the LDSC/SSN programme and service availability and facility readiness emphasises the significance of targeted training and mentorship programmes in enhancing newborn care across Nepal.

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Section: Discussionsupporting

confidence: 90%

An assessment of immediate newborn care readiness and availability in Nepal

Dhungana,

Chalise,

Clark

2023

Global Health Action

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“…Healthcare providers’ awareness of implicit bias is not well documented in the context of Nepal and our literature review revealed very few previous studies in Nepal gave this topic even a passing mention37 (for an exception see38). However, it is evident that implicit bias is significantly related to patient-provider interactions, treatment decisions and patient health outcomes in all contexts,33 and certainly will be in Nepal.…”

Section: Discussionmentioning

confidence: 87%

Gender and caste inequalities in primary healthcare usage by under-5 children in rural Nepal: an iterative qualitative study into provider perspectives and the potential role of implicit bias

et al. 2023

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ObjectiveThis study explored provider perspectives on: (1) why inequalities in health service usage persist; and (2) their knowledge and understanding of the role of patient experience and implicit bias (also referred to as unconscious bias).DesignA three stage, iterative qualitative study was conducted involving two rounds of in-depth interviews and a training session with healthcare staff. Interview transcripts were analysed using a reflexive thematic approach in relation to the study’s aims.SettingParticipants were recruited from rural hill districts (Mugu, Humla, Bajura, Gorkha and Sindhupalchok) of Nepal.ParticipantsClinical staff from 22 rural health posts.ResultsHealthcare providers had high levels of understanding of the cultural, educational and socioeconomic factors behind inequalities in healthcare usage in their communities. However, there was less knowledge and understanding of the role of patient experience—and no recognition at all of the concept of implicit bias.ConclusionIt is highly likely that implicit bias affects provider behaviours in Nepal, just as it does in other countries. However, there is currently not a culture of thinking about the patient experience and how that might impact on future usage of health services. Implicit bias training for health students and workers would help create greater awareness of unintended discriminatory behaviours. This in turn may play a part in improving patient experience and future healthcare usage, particularly among disadvantaged groups.

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Mistreatment during childbirth and postnatal period reported by women in Nepal —a multicentric prevalence study

Gurung

Moinuddin

Sunny

et al. 2022

BMC Pregnancy Childbirth

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Introduction Trust of women and families toward health institutions has led to increased use of their services for childbirth. Whilst unpleasant experience of care during childbirth will halt this achievement and have adverse consequences. We examined the experience of women regarding the care received during childbirth in health institutions in Nepal. Method A prospective cohort study conducted in 11 hospitals in Nepal for a period of 18 months. Using a semi-structured questionnaire based on the typology of mistreatment during childbirth, information on childbirth experience was gathered from women (n = 62,926) at the time of discharge. Using those variables, principal component analysis was conducted to create a single mistreatment index. Bivariate and multivariate linear regression analyses were conducted to assess the association of the mistreatment index with sociodemographic, obstetric and newborn characteristics. Result A total of 62,926 women were consented and enrolled in the study. Of those women, 84.3% had no opportunity to discuss any concerns, 80.4% were not adequately informed before providing care, and 1.5% of them were refused for care due to inability to pay. According to multivariate regression analysis, women 35 years or older (β, − 0.3587; p-value, 0.000) or 30–34 years old (β,− 0.38013; p-value, 0.000) were less likely to be mistreated compared to women aged 18 years or younger. Women from a relatively disadvantaged (Dalit) ethnic group were more likely to be mistreated (β, 0.29596; p-value, 0.000) compared to a relatively advantaged (Chettri) ethnic group. Newborns who were born preterm (β, − 0.05988; p-value, 0.000) were less likely to be mistreated than those born at term. Conclusion The study reports high rate of some categories of mistreatment of women during childbirth. Women from disadvantaged ethnic group, young women, and term newborns are at higher risk of mistreatment. Strengthening health system and improving health workers’ readiness and response will be key in experience respectful care during childbirth.

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Mistreatment of newborns after childbirth in health facilities in Nepal: Results from a prospective cohort observational study

Cited by 6 publications

References 25 publications

An assessment of immediate newborn care readiness and availability in Nepal

An assessment of immediate newborn care readiness and availability in Nepal

Gender and caste inequalities in primary healthcare usage by under-5 children in rural Nepal: an iterative qualitative study into provider perspectives and the potential role of implicit bias

Mistreatment during childbirth and postnatal period reported by women in Nepal —a multicentric prevalence study

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