My Republica, August 13, 2020
KATHMANDU: A study has found that the nationwide lockdown has taken its toll in institutional childbirth, stillbirth and neonatal mortality and quality of care in Nepal.
According to a study published in Lancet, institutional childbirth was reduced by more than half during lockdown in Nepal. "From the beginning to the end of the study period, the mean weekly number of births decreased from 1261·1 births before lockdown to 65·4 births during lockdown—a reduction of 52·4 percent," the study said.
Also, the lockdown has spurred institutional stillbirth and neonatal mortality.
"The institutional stillbirth rate has increased from 14 per 1000 total births before lockdown to 21 per 1000 total births during lockdown and institutional neonatal mortality increased from 13 per 1000 live births to 40 per 1000 live births," said the report.
The study was done between January 1 and May 30, 2020, covering nine hospitals across all seven provinces. The study period included 12·5 weeks before the national lockdown and 9·5 weeks during the lockdown. The study covered 21,754 pregnant women during the study period. Of them 20,354 gave birth, and health workers performance was recorded for 10, 543 births.
"A decrease was seen in the coverage of intrapartum fetal heart rate monitoring during labour and in breastfeeding within one hour of birth, but some improvements were seen in some immediate newborn care practices, such as skin-to-skin contact, and hand hygiene practice," said the report.
In terms of quality of care, intrapartum fetal heart rate monitoring decreased by 13·4 percent and breastfeeding within one hour of birth decreased by three percent.
The study has recorded improvements in hand hygiene and newborn care practice.
"The immediate newborn care practice of placing the baby skin-to-skin with their mother increased by 13·2 per cent and health workers' hand hygiene practices during childbirth increased by 12·9 per cent during lockdown," it said.
"During the COVID-19 pandemic, women and their babies (both in utero and neonates) are susceptible and at risk due to gaps in care that can result in adverse birth outcomes including mortality," the report said in its summary.
"Pandemic lockdowns threaten lives and jeopardise progress that has been made in the past two decades in Nepal, potentially derailing on-track efforts to achieve the Sustainable Development Goals by 2030, especially for maternal and neonatal survival, and efforts to build stronger health systems after the pandemic," it said.
The study has suggested taking urgent action to prevent such casualties.
"An urgent need exists to protect access to high quality intrapartum care and prevent excess deaths for the most vulnerable health system users during this pandemic period, " it recommends.
The researchers have claimed that the study was one of the first and largest documentations of service reduction during COVID-19. This study was funded by Grand Challenges Canada, which is funded by the Government of Canada. A team of 12 researchers, both from Nepal and abroad, were involved in the study.