ORCID Profile
0000-0002-0541-4486
Current Organisation
University of Gothenburg
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Publisher: Wiley
Date: 02-01-2020
DOI: 10.1111/JPC.14703
Abstract: The aim of this study was to identify the incidence, risk factors and outcome associated with meconium aspiration syndrome (MAS). An observational study was conducted in 12 public hospitals in Nepal from 1 July 2017 to 29 August 2018. All babies born within the study period were included in the study. Babies who were diagnosed as MAS were designated as outcome. Data were analysed with bivariate analysis followed by multiple regression analysis. The overall incidence of MAS was 2.0 per 1000 livebirths. Babies born at post-term gestation (adjusted odds ratio (AOR) = 2.41 95% confidence interval (CI): 1.05-5.55), nulliparity (AOR = 2.26 95% CI: 1.20-4.28), instrumental delivery (AOR = 4.79 95% CI: 2.52-9.10) and caesarean delivery (AOR = 3.67 95% CI: 2.29-5.89) were significantly associated with MAS. Babies with MAS had a 10-fold risk for pre-discharge mortality (odds ratio = 9.87 95% CI: 5.81-16.76). The findings in this study are consistent with that reported in other studies. MAS has a high risk of neonatal mortality. Thus, monitoring during pregnancy and labour is necessary for early identification of high-risk conditions associated with MAS. Strengthening of newborn care services is essential to curtail mortality.
Publisher: Springer Science and Business Media LLC
Date: 29-11-2019
DOI: 10.1007/S10995-019-02827-Z
Abstract: Globally, 2.6 million stillbirths occur each year. Empowering women can improve their overall reproductive health and help reduce stillbirths. Women empowerment has been defined as women’s ability to make choices in economic decision-making, household and health care decision-making. In this paper, we aimed to evaluate if women’s empowerment is associated with stillbirths. Data from 2016 Nepal Demographic Health Surveys (NDHS) were analysed to evaluate the association between women’s empowerment and stillbirths. Equiplots were generated to assess the distribution of stillbirths by wealth quintile, place of residence and level of maternal education using data from NHDS 1996, 2001, 2006, 2011 and 2016 data. For the association of women empowerment factors and stillbirths, univariate and multivariate analyses were conducted. A total of 88 stillbirths were reported during the survey. Univariate analysis showed age of mother, education of mother, age of husband, wealth index, head of household, decision on healthcare and decision on household purchases had significant association with stillbirths (p 0.05). In multivariate analysis, only maternal age 35 years and above was significant (aOR 2.42 1.22–4.80). Education of mother (aOR 1.48 0.94–2.33), age of husband (aOR 1.54 0.86–2.76), household head (aOR 1.51 0.88–2.59), poor wealth index (aOR 1.62 0.98–2.68), middle wealth index (aOR 1.37 0.76–2.47), decision making for healthcare (aOR 1.36 0.84–2.21) and household purchases (aOR 1.01 0.61–1.66) had no any significant association with stillbirths. There are various factors linked with stillbirths. It is important to track stillbirths to improve health outcomes of mothers and newborn. Further studies are necessary to analyse women empowerment factors to understand the linkages between empowerment and stillbirths.
Publisher: Springer Science and Business Media LLC
Date: 24-01-2020
DOI: 10.1007/S10995-020-02881-Y
Abstract: Almost all preventable neonatal deaths take place in low- and middle-income countries and affect the poorest who have the least access to high quality health services. Cost of health care is one of the factors preventing access to quality health services and universal health coverage. In Nepal, the majority of expenses related to newborn care are borne by the caregiver, regardless of socioeconomic status. We conducted a study to assess the out of pocket expenditure (OOPE) for sick newborn care in hospitals in Nepal. This cross-sectional study of hospital care for newborns was conducted in 11 hospitals in Nepal and explored OOPE incurred by caregivers for sick newborn care. Data were collected from the caregivers of the sick newborn on the topics of cost of travel, accommodation, treatment (drugs, diagnosis) and documented on a sick newborn case record form. Data were collected from 814 caregivers. Cost of caregivers’ stay accounted for more than 40% of the OOPE for sick newborn care, followed by cost of travel, and the baby’s stay and treatment. The overall OOPE ranged from 13.6 to 226.1 US dollars (USD). The median OOPE was highest for preterm complications ($33.2 USD CI 14.0–226.1), followed by hyperbilirubinemia ($31.9 USD CI 14.0–60.7), respiratory distress syndrome ($26.9 USD 15.3–121.5), neonatal sepsis ($ 25.8 USD CI 13.6–139.8) and hypoxic ischemic encephalopathy ($23.4 USD CI 13.6–97.7). In Nepal, OOPE for sick newborn care in hospitals varied by neonatal morbidity and duration of stay. The largest proportion of OOPE were for accommodation and travel. Affordable and accessible health care will substantially reduce the OOPE for sick newborn care in hospitals.
Publisher: Springer Science and Business Media LLC
Date: 17-07-2020
DOI: 10.1186/S13690-020-00446-7
Abstract: Preterm birth is a worldwide epidemic and a leading cause of neonatal mortality. In this study, we aimed to evaluate the incidence, risk factors and consequences of preterm birth in Nepal. This was an observational study conducted in 12 public hospitals of Nepal. All the babies born during the study period were included in the study. Babies born 37 weeks of gestation were classified as preterm births. For the association and outcomes for preterm birth, univariate followed by multiple regression analysis was conducted. The incidence of preterm was found to be 93 per 1000 live births. Mothers aged less than 20 years (aOR 1.26 .15–1.39) had a high risk for preterm birth. Similarly, education of the mother was a significant predictor for preterm birth: illiterate mothers (aOR 1.41 1.22–1.64), literate mothers (aOR 1.21 1.08–1.35) and mothers having basic level of education (aOR 1.17 1.07–1.27). Socio-demographic factors such as smoking (aOR 1.13 1.01–1.26), use of polluted fuel (aOR 1.26 1.17–1.35) and sex of baby (aOR 1.18 1.11–1.26) obstetric factors such as nulliparity (aOR 1.33 1.20–1.48), multiple delivery (aOR 6.63 5.16–8.52), severe anemia during pregnancy (aOR 3.27 2.21–4.84), antenatal visit during second trimester (aOR 1.13 1.05–1.22) and third trimester (aOR 1.24 1.12–1.38), 4 antenatal visits during pregnancy (aOR 1.49 1.38–1.61) were found to be significant risk factors of preterm birth. Preterm has a risk for pre-discharge mortality (10.60 9.28–12.10). In this study, we found high incidence of preterm birth. Various socio-demographic, obstetric and neonatal risk factors were associated with preterm birth. Risk factor modifications and timely interventions will help in the reduction of preterm births and associated mortalities. ISRCTN30829654 .
Publisher: Springer Science and Business Media LLC
Date: 28-10-2019
DOI: 10.1186/S12887-019-1723-0
Abstract: Maintaining neonatal resuscitation skills among health workers in low resource settings will require continuous quality improvement efforts. We aimed to evaluate the effect of skill drills and feedback on neonatal resuscitation and the optimal number of skill drills required to maintain the ventilation skill in a simulated setting. An observational study was conducted for a period of 3 months in a referral hospital of Nepal. Sixty nursing staffs were trained on Helping Babies Breathe (HBB) 2.0 and daily skill drills using a high-fidelity manikin. The high-fidelity manikin had different clinical case scenarios and provided feedback as “well done” or “improvement required” based on the ventilation performance. Adequate ventilation was defined as bag-and-mask ventilation at the rate of 40–60 breaths per minute. The effective ventilation was defined as adequate ventilation with a “well done” feedback. We assessed the correlation of number skill drills and clinical case scenario with adequate ventilation rate using pearson’s correlation. We assessed the correlation of number of skill dills performed by each participant with effective ventilation using Mann Whitney test. Among the total of 60 nursing staffs, all of them were competent with an average score of 12.73 ± 1.09 out of 14 ( p 0.001) on bag-and-mask ventilation skill checklist. Among the trained staff, 47 staffs participated in daily skill drills who performed a total of 331 skill drills and 68.9% of the ventilations were done adequately. Among the 47 nursing staffs who performed the skill drills, 228 (68.9%) drills were conducted at a ventilation rate of 40–60 breathes per minute. There was no correlation of the adequate ventilation with skill drill category ( p = 0.88) and the level of skill performed ( p = 0.28). Out of 47 participants performing the skill drills, 74.5% of them had done effective ventilation with a mean average of 8 skill drills (SD ± 4.78) ( p -value- 0.032). In a simulated setting, participants who had an average skill drill of 8 in 3 months had effective ventilation. We demonstrated optimal skill drill sessions for maintain the neonatal resuscitation competency. Further evaluation will be required to validate the findings in a scale up setting.
Publisher: Springer Science and Business Media LLC
Date: 12-2020
DOI: 10.1186/S12884-020-03456-Z
Abstract: Simulation-based training in neonatal resuscitation is more effective when reinforced by both practice and continuous improvement processes. We aim to evaluate the effectiveness of a quality improvement program combined with an innovative provider feedback device on neonatal resuscitation practice and outcomes in a public referral hospital of Nepal. A pre- and post-intervention study will be implemented in Pokhara Academy of Health Sciences, a hospital with 8610 deliveries per year. The intervention package will include simulation-based training (Helping Babies Breathe) enhanced with a real-time feedback system (the NeoBeat newborn heart rate meter with the NeoNatalie Live manikin and upright newborn bag-mask with PEEP) accompanied by a quality improvement process. An independent research team will collect perinatal data and conduct stakeholder interviews. This study will provide further information on the efficiency of neonatal resuscitation training and implementation in the context of new technologies and quality improvement processes. 10.1186/ISRCTN18148368 , date of registration-31 July 2018
Publisher: Springer Science and Business Media LLC
Date: 19-06-2019
Publisher: Springer Science and Business Media LLC
Date: 17-12-2019
DOI: 10.1007/S10995-019-02846-W
Abstract: Nepal has pledged to substantially reduce maternal and newborn death by 2030. Improving quality of intrapartum health services will be vital to reduce these deaths. This paper examines quality of delivery and newborn services in health facilities of Nepal. Data were sourced from the Nepal Health Facility Survey 2015, which covered a national representative s le of health facilities. The datasets were analysed to assess service readiness, availability and quality of delivery and newborn care in a s le of 992 health facilities. Of the 992 facilities in the s le, 623 provided delivery and newborn care services. Of the 623 facilities offering delivery and newborn care services, 13.3% offered comprehensive emergency obstetric care (CEmONC), 19.6% provided basic emergency obstetric care (BEmONC) and 53.9% provided basic delivery and newborn service. The availability of essential equipment for delivery and newborn care was more than 80% in health facilities. Except for the coverage of vitamin K injection, the coverage of immediate newborn care was more than 85% in all health facilities. The coverage of use of chlorhexidine ointment to all newborns was more than 70% in government hospitals and primary health care centers (PHCCs) and only 32.3% in private hospitals. These findings show gaps in equipment and drugs, especially in PHCCs and private health facilities. Improving readiness and availability of equipment and drugs in PHCCs and private health facility will help improve the quality of care to further reduce maternal and newborn mortality in Nepal.
Publisher: Springer Science and Business Media LLC
Date: 27-02-2023
DOI: 10.1038/S41562-023-01522-Y
Abstract: Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from −90% to +30%, were reported in many countries following early COVID-19 pandemic response measures (‘lockdowns’). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95–0.98, P value .0001), second (0.96, 0.92–0.99, 0.03) and third (0.97, 0.94–1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96–1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88–1.14, 0.98), third (0.99, 0.88–1.12, 0.89) and fourth (1.01, 0.87–1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02–1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03–1.15, 0.002), third (1.10, 1.03–1.17, 0.003) and fourth (1.12, 1.05–1.19, .001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways.
Publisher: Informa UK Limited
Date: 23-01-2022
Publisher: Public Library of Science (PLoS)
Date: 09-09-2019
Publisher: Springer Science and Business Media LLC
Date: 27-11-2019
DOI: 10.1007/S10995-019-02817-1
Abstract: The nutritional status in the first 5 years of life has lifelong and inter-generational impacts on in idual’s potential and development. This study described the trend of stunting and its risk factors in children under 5 years of age between 2001 and 2016 in Nepal. The study used datasets from the 2001, 2006, 2011 and 2016 Nepal Demographic Health Surveys to describe the trend of stunting in under 5-year children. Multiple logistic regression analysis was carried out to assess the risk factors for stunting at the time of the four surveys. The nutritional status of under 5-year children improved between 2001 and 2016. Babies born into poorer families had a higher risk of stunting than those born into wealthier families (AOR 1.51, CI 95% 1.23–1.87). Families residing in hill districts had less risk of stunting than those in the Terai plains (AOR 0.75, CI 95% 0.61–0.94). Babies born to uneducated women had a higher risk of stunting than those born to educated women (AOR 1.57, CI 95% 1.28–1.92). Stunting among under-5-year children decreased in the years spanning 2001–2016. This study demonstrated multiple factors that can be addressed to decrease the risk of stunting, which has important implications for neurodevelopment later in life. We add literature on risk factors for stunting in under-5-year children.
Publisher: Springer Science and Business Media LLC
Date: 26-11-2019
DOI: 10.1007/S10995-019-02826-0
Abstract: Nepal has made considerable progress on improving child survival during the Millennium Development Goal period, however, further progress will require accelerated reduction in neonatal mortality. Neonatal survival is one of the priorities for Sustainable Development Goals 2030. This paper examines the trends, equity gaps and factors associated with neonatal mortality between 2001 and 2016 to assess the likelihood of Every Newborn Action Plan (ENAP) target being reached in Nepal by 2030. This study used data from the 2001, 2006, 2011 and 2016 Nepal Demographic and Health Surveys. We examined neonatal mortality rate (NMR) across the socioeconomic strata and the annual rate of reduction (ARR) between 2001 and 2016. We assessed association of socio-demographic, maternal, obstetric and neonatal factors associated with neonatal mortality. Based on the ARR among the wealth quintile between 2001 and 2016, we made projection of NMR to achieve the ENAP target. Using the Lorenz curve, we calculated the inequity distribution among the wealth quintiles between 2001 and 2016. In NDHS of 2001, 2006, 2011 and 2016, a total of 8400, 8600, 13,485 and 13,089 women were interviewed respectively. There were significant disparities between wealth quintiles that widened over the 15 years. The ARR for NMR declined with an average of 4.0% between 2001 and 2016. Multivariate analysis of the 2016 data showed that women who had not been vaccinated against tetanus had the highest risk of neonatal mortality (adjusted odds ratio [AOR] 3.38 95% confidence interval [CI] 1.20–9.55), followed by women who had no education (AOR 1.87 95% CI 1.62–2.16). Further factors significantly associated with neonatal mortality were the mother giving birth before the age of 20 (AOR 1.76 CI 95% 1.17–2.59), household air pollution (AOR 1.37 CI 95% 1.59–1.62), belonging to a poorest quintile (AOR 1.37 CI 95% 1.21–1.54), residing in a rural area (AOR 1.28 CI 95% 1.13–1.44), and having no toilet at home (AOR 1.21 CI 95% 1.06–1.40). If the trend of neonatal mortality rate of 2016 continues, it is projected that the poorest family will reach the ENAP target in 2067. Although neonatal mortality is declining in Nepal, if the current trend continues it will take another 50 years for families in the poorest group to attain the 2030 ENAP target. There are different factors associated with neonatal mortality, reducing the disparities for maternal and neonatal care will reduce mortality among the poorest families.
No related grants have been discovered for Ashish KC.