Papers

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

David Osrin, clinical research fellow, ^a Kirti M Tumbahangphe, senior monitoring and surveillance officer, ^b Dej Shrestha, senior data management officer, ^b Natasha Mesko, research fellow, ^a Bhim P Shrestha, programme manager, ^b Madan K Manandhar, director, centre for local governance, ^c Hilary Standing, research fellow, health and social change unit, ^d Dharma S Manandhar, director, ^b Anthony M de L Costello, professor. ^a

^a International Perinatal Care Unit, Institute of Child Health, University College London, London WC1N 1EH, ^b Mother Infant Research Activities, GPO Box 921, Kathmandu, Nepal, ^c Nepal Administrative Staff College, Kathmandu, Nepal, ^d Institute of Development Studies, Falmer, Sussex BN1 9RH

Correspondence to: A M de L Costello ipu{at}ich.ucl.ac.uk

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 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 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