Uncategorized – Golden Community

Implementing Respectful Maternity Care (RMC) Intervention to Improve Perinatal Mental Health

admin — Mon, 13 Mar 2023 09:01:11 +0000

Several studies in low- and middle-income settings have shown that mistreatment and disrespectful care during childbirth is a major issue that needs addressing. A multi-country study by Bohren et al. showed that more than a third of women experience disrespectful care during childbirth. Mothers face physical and verbal abuse as well as discrimination based on age, ethnicity and social class . Other types of abuse are non-consented care or painful vaginal examination, and restraining from having companionship or food during childbirth . Lack of dignified care during the vulnerable time during birth not only violates the universal right of childbearing women but also influences the overall quality of care . There is some early evidence to suggest that women experiencing disrespect and abuse are more likely to experience common perinatal mental disorders. Common perinatal mental disorders include depressive, anxiety, adjustment and somatic disorders. In low- and middle-income countries, 19.7% of women suffer common perinatal mental disorders during pregnancy and 39.4% suffer from the disorders during postpartum period . While there is a growing body of literature on disrespectful care in sub-Saharan African and Latin America, there is limited literature on the topic from Asia, including Nepal.

Improving Adherence to Neonatal Resuscitation Using Machine Learning at Quality Improvement Approach (Pre-MALA)

admin — Mon, 13 Mar 2023 08:59:32 +0000

High quality neonatal resuscitation is a key to save newborn lives, prevent brain injury and optimize child development, yet the quality of care remains far below standards. In this project, we investigate the use of video filming of neonatal resuscitation (source of data) to develop a machine learning application which automatically detects neonatal resuscitation activity. This artificial intelligence system will assist to standardize resuscitation in neonates requiring assisted ventilation on the resuscitation table. The MAchine Learning Application (MALA) installed in a tablet mounted on the resuscitation table detects the baby’s crying (sound), breathing (chest movement) and health worker’s resuscitation action (stimulation, suctioning and bag-and-mask ventilation), and provides real-time feedback (reminder) on steps of resuscitation.The real-time feedback will be in the form of audio and visual signals from the tablet during resuscitation. Following the completion of resuscitation, MALA provides a summary feedback on the resuscitation steps followed as per the resuscitation guideline.

Feasibility of Remote General Movements Assessment (GMA) for Early Recognition and Rehabilitation of Cerebral Palsy in Nepal

admin — Mon, 13 Mar 2023 08:58:48 +0000

Cerebral Palsy (CP) is a syndrome of non-progressive movement and posture disorder caused by damage to the developing brain during pregnancy, delivery or first two years of life. It is the most common form of motor disability in childhood affecting around 2-3 children per 1000 live births. Early intervention started during the first two years of life has been shown to improve functional outcome in children at risk of CP. Novel tools enable early recognition of these children, but access to early diagnosis is limited in Low- and Middle-Income Countries (LMIC), where the majority of affected children live. Facility based studies in Nepal show that many children with CP access rehabilitation first around school age. This missed opportunity results in decreased quality of life for both affected children and their parents.

General Movements Assessment (GMA) is a cheap, non-invasive method for recognizing children at high risk of CP based on observing their spontaneous movements. Already at 3 months’ age it can predict CP with over 90% sensitivity and specificity enabling start of early rehabilitation interventions for children at high risk of CP. Lack of doctors and physiotherapists trained in the methodology has thus far limited its spread to LMIC, but smart phone technology can help to overcome this barrier.

Studies in high-income settings have shown that GMA can be administered remotely using video films recorded by parents at home with help of a smart phone application (app).

Study Aim:

We aim to conduct a follow up study on feasibility of remote General Movements Assessment (GMA) using smart phones at home through an application at Paropakar Maternity and Women’s Hospital (PMWH). Term infants at high risk of CP due to birth asphyxia or neonatal seizures will be recruited for the follow-up.

Navigating Food Insecurity During the Pandemic: The Role of Social Networks Among Pregnant Women in Nepal

admin — Mon, 13 Mar 2023 08:58:10 +0000

Food insecurity is defined as a state in which an individual “lacks regular access to sufficient, safe and nutritious food to meet the needs for normal growth and development and to maintain an active and healthy lifestyle” (FAO, 2020). An individual may become food insecure due to a combination of factors, including lack of resources to obtain food and/or unavailability of food are some. Not all people are equally vulnerable to food insecurity at all times. Pregnancy is a particularly vulnerable period as the nutritional requirements of the pregnant woman are higher than normal. The lived experience of food insecurity can be influenced by a number of socio-economic factors. The impact of social networks on health outcomes has been the subject of extensive social and medical research in recent decades.

Food insecurity increased rapidly during Covid-19, and the pandemic seriously interrupted severely disrupted social support networks. Nepal is no exception when it comes to consequences of Covid-19 on food insecurity and social networks. The Ministry of Agriculture and Livestock Development in Nepal reported that 58% of the households did not have food stocks for more than a month and three out of ten households lost their income during the worst crisis of Covid-19. While the general importance of social networks for health is well established, few studies have examined the impact of social networks on food insecurity in LMICS.

No studies have explored the role of social networks in the lived experience of food insecurity among pregnant women. However, there are good reasons to believe that the general factors such as social support and access to material resources and goods may also be important in this context. This project explored the lived experiences of food insecurity among pregnant women in Nepal from a qualitative social network perspective in in the Chitwan district including 10 Tharu women who were pregnant during the Covid-19 pandemic.

Investigating heat wave risk perception, vulnerability and adaptation among pregnant women

admin — Mon, 13 Mar 2023 08:58:45 +0000

Over the past 15 years, Nepal has experienced a series of catastrophic weather events, with the Terai region emerging as the hottest part of the country. The prevalence of warm days and nights is increasing in Nepal’s districts. According to the Department of Hydrology and Meteorology, June 2023 marked the hottest month ever recorded in Nepal’s history with temperature rising up to 44 degrees Celsius in some part of the country. Several studies have shown an increase in preterm births in geographical locations where pregnant women is exposed to high ambient temperatures or heatwaves. A meta-analysis of 47 studies found that for every 1-degree Celsius increase in temperature, the odds of preterm birth increased by 1.05 times, and during heatwaves by 1.16 times. Furthermore, the risk of a stillbirth is increased by 1.05 times for every 1-degree Celsius increase in temperature. During periods of extreme heat, pregnant women may exhibit an increased frequency of visits to the emergency room and a higher incidence of cardiovascular events such as myocardial infarction and stroke.

Pregnant women are notably excluded from the definition of “heat-susceptible individuals” as defined in the existing research. There is evidence that extreme maternal stress associated with extreme weather events has adverse effects on the child health outcome. The main aim of this study is to test the hypothesis that women with continuous exposure to high ambient temperatures may experience depressive symptoms during perinatal period and subsequent child developmental delays and disabilities at Bharatpur Hospital, Chitwan involving 745 pregnant mothers in their third trimester using Generalized Anxiety Disorder (GAD) and Edinburgh Postnatal Depression Scale (EPDS) tools. The babies of these cohort mothers were screened for developmental delays and disabilities using SNAP (Special Need Assessment Profile) and IYCD (Infant and Young Child Development) at 6, 12 months, 18 months, and 24 months of age.

Every Newborn – Simplified Measurement Integrating Longitudinal Neuro Development and Growth (EN-SMILING)

admin — Mon, 13 Mar 2023 08:58:02 +0000

In low- and middle-income countries, there has been a noticeable decline in mortality rates among children under 5 years old, a trend expected to continue. However, it is estimated that over 200 million children in these countries have developmental delays or disabilities, highlighting the need for their recognition and inclusion in all health practices and planning. Consequently, the focus has shifted from reducing child mortality rates to improving health and developmental outcomes in childhood. While newborn and early child health present opportunities for early detection and intervention, current approaches to measuring early childhood development (ECD) are often too complex, costly, and time-consuming. Additionally, although basic interventions may improve newborn survival, their impact on ECD outcomes remains poorly understood. ENSMILING aims to address this issue by designing a simplified ECD measurement approach for children from birth to age 5, potentially enabling earlier identification of developmental delays and improved access to evidence-based early intervention.

EN-SMILING builds on the research of EN-BIRTH, a multi-country observational study led by the London School of Hygiene and Tropical Medicine (LSHTM) in Bangladesh, Tanzania, and Nepal. The research project involved follow-up of a group of newborns born in Western Regional Hospital, Pokhara, Nepal who received basic newborn interventions (bag and mask resuscitation, Kangaroo Mother Care (KMC), and treatment for presumed neonatal infection) compared to matched newborns born in the same hospital at the same point of time. Multiple early child development tools were applied for the developmental assessment of these children from birth to 3 years of age at 6, 9, 12, 18, 24, and 36 months of age. The WHO IYCD (Indicators of Infant and Young Child Development) tool, the Caregiver Reported Early Development Instruments (CREDI), the Malawi Developmental Assessment Tool (MDAT), Rapid Neurodevelopmental Assessment (RNDA), Family Care Indicator (FCI) were utilized after pilot testing and cultural adaptation of the tools.

Scaling Up Safer Birth Bundle Through Quality Improvement in Nepal (SUSTAIN)

admin — Mon, 13 Mar 2023 08:31:08 +0000

Golden community in collaboration with the Ministry of health and Population, Government of Nepal (GoN) and Uppsala University has scaled up a set of quality improvement interventions specific to improving intrapartum care aimed atreducing intrapartum related mortality (intrapartum stillbirth and neonatal death within first 24 hours of life) in Nepal.

SUSTAIN has been implemented in different public hospitals of Nepal: Koshi Hospital, Janakpur Hospital; Bharatpur Hospital; Lumbini Provincial Hospital; Bheri Hospital; Province hospital, Karnali; Seti Provincial Hospital and Dadeldhura Hospital. The programme is financially supported by Grand Challenges Canada, Canada and commodity grant supported by Laerdal Global Health, Norway for a period of two years from April,2019.

Design framework of SUSTAIN Package

SUSTAIN package includes:

Set of quality interventions

- Orientation of SUSTAIN and its components to concerned stakeholders
- Bottleneck analysis around maternal and newborn care services
- Plan Do Study Act meetings to solve the problems related to newborn and maternal services within the department
- Progress boards with major newborn indicators
- Daily Skill checks using advanced neonatalie (to maintain ventilation skills of health workers with Low Dose High Frequency approach)
- Helping Babies Survive Training in partnership with National Health Training Center and Nepal Paediatric Society: A four-day training around the care of newborn. There are four components: Helping Babies Breathe,second edition; essential care for every newborn; essential care for small babies; PDSA model/meeting
- Mentoring and Review meetings with stakeholders at provincial and central level.

Safer Birth Bundle

Moyo foetal heart rate monitor (shows real-time heart rate of foetus)
NeoBeat newborn heart rate meter (shows real-time heart rate of newborns at birth)
Advanced Neonatalie (automated feedback providing manikin during ventilation skill checks)
Upright resuscitator (maintains proper sealing of mask during ventilation)
Penguin suction (restricts deep suctioning and is portable)

Simulated Based Education- Operational Research

admin — Wed, 08 Mar 2023 06:58:42 +0000

Effectiveness of Simulation Based Education on midwifery skills among pre-service and in – service trainees from selected institutes of Nepal

An operational research for a period of 2 years among pre-service midwifery students and in-service trainees aims to evaluate the effectiveness of SBE in their competency as well as to evaluate the feasibility of implementation.

GIZ in collaboration with Laerdal has established Simulated Based education lab in two midwifery institutions and seven skilled birth attendant (SBA) sites of Nepal in partnership with NHTC. For pre-service participants, the study will be conducted in two institutions – Kathmandu University (KU) and National Academy of Medical Sciences (NAMS) where Bachelor of Midwifery is being taught. In case of in–service participants, preliminary data will be collected from the training site in Kathmandu and the follow-up assessments will be done in their respective training sites over a period of six months.

A mixed method will be used to assess knowledge, skill competency and perception of the participants before simulation-based training and at six months following the training. Barrier and enabler for the initiation of SBE lab in the educational institution and training center will be assessed through In Depth Interview and Focus Group Discussion with faculties, SBA trainers, Institution head, representatives of government body (NHTC) and partner organization.

Rapid Feedback for quality Improvement Neonatal Resuscitation (REFINE)

admin — Mon, 13 Mar 2023 08:55:08 +0000

Rapid Feedback for quality Improvement Neonatal Resuscitation (REFINE) Study

The REFINE study is being carried out in Pokhara Academy of Health Sciences/Western Regional Hospital in Pokhara since November 2018. The aim of the study is to improve maternal and newborn outcomes by capacitating health workers with the use of high-end technologies, Moyo fetal heart rate monitor and NeoBeat newborn heart rate meter which provide real-time heart rate feedback of foetus and newborns respectively. The study is supported by Laerdal Global Health, Stavanger, Norway.

The health workers were provided orientation and training on how to use Moyo and NeoBeat. In this study, Moyo is used when a pregnant woman enters into the active stage of labour to continuously monitor foetal heart rate (FHR). Also, after a baby is born, the NeoBeat is affixed to the newborn to assess heart rate instantly. These two devices will guide health workers for timely decision-making should any obstetric and newborn complications occur and intervene accordingly. Data collectors are available round the clock in the labour room to collect information on the use of Moyo and NeoBeat in labour room. They also collect data using tablet-based application (Liveborn App) for every newborn.

Based on the dashboard created every month from the app, Plan, Do, Study, Act (PDSA) meeting is held to discuss on the issues related to resuscitation parameters (suctioning & time to first ventilation). The meetings serve as a platform to discuss and analyse possible shortcomings and improvements to be made in the performance of health workers working in labour room.

Scaling Up Helping Babies Breathe Quality Improvement Cycle

admin — Mon, 13 Mar 2023 08:29:08 +0000

Uppsala University and Golden Community in partnership with Ministry of Health and Population, Government of Nepal (GoN) in implementing quality improvement of perinatal care in public hospitals of Nepal.

Recent preliminary findings from Nepal Demographic Health Survey (NDHS) 2016 show that Nepal has made considerable progress in reducing childhood mortality. Whilst achieving Millennium Development Goal (MDG) 4, neonatal mortality remained the same over the years. Nepal’s Newborn Action Plan (NeNAP) has pledged to reduce neonatal mortality rate to 11 per 1000 live births and stillbirth rate to 13 per 1000 total births by 2030 (currently 21/1000 live births; NDHS 2016).

Ending preventable maternal and newborn deaths and stillbirths will be one of the major focuses of Ministry of Health in the coming years, through the commitment made in NeNAP. These targets will not be achieved without improving the quality of care around the time of birth and for small and sick newborns. In this regard, CHD has taken initiative to introduce a multi-faceted ‘Quality Improvement (QI)’ intervention in hospitals focusing on the improvement of perinatal care quality. The approach is based on WHO’s “Standards for Improving Quality of Maternal and Newborn Care in Health Facilities” and “Nepal’s Every Newborn Action Plan”. GC will evaluate the implementation of quality improvement in selected public hospitals and work in close collaboration with Uppsala University.