Hari Bahadur Rana1, Megha Raj Banjara2, Mahesh Prasad Joshi1, Ann E Kurth3, Theresa P Castillo4. 1. HealthRight International, Kathmandu, Nepal. 2. Public Health and Infectious Disease Research Center, Kathmandu, Nepal. 3. Yale School of Nursing, West Haven, CT, USA. 4. Women and Children's Health Programs, HealthRight International, New York, NY, USA.
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 in Nepal is feasible through the existing government health system.
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 in Nepal is feasible through the existing government health system.