Neonatal resuscitation capacity in Nepal

Perinatal asphyxia is a major contributor to the nearly 4 million neonatal deaths worldwide each year in resource-limited settings. Neonatal resuscitation, a proven method for preventing newborn deaths, is effective only when local caregivers have proper training and access to essential supplies. There are few published data describing neonatal resuscitation capacity in Nepal, where neonatal mortality rates are high. The goal of this study was to quantify neonatal resuscitation capacity at birthing sites in urban and rural Nepal.

Seventeen birth centres ranging from tertiary care hospitals to rural health posts were evaluated. Assessments included standardised interviews of health-care workers and evaluation of newborn resuscitation areas. The availability of essential resuscitation tools was recorded.

Eleven of the 17 health centres conducted deliveries on-site. Of those, 45% had posted and visible resuscitation algorithms; 72% had infant warmers; 91% had mechanical suction machines; 36% had bulb suctions and 82% had bag-mask ventilation devices available. Tertiary hospitals were much better equipped compared with smaller health centres. None of the health-care workers who attended home deliveries had access to algorithms, warming devices, suction or bag-mask ventilation devices.

Availability of appropriate resuscitation supplies was variable in health centres providing delivery services on-site and was severely deficient among health staff attending to home deliveries. Limited availability of resuscitation equipment may contribute to the high neonatal mortality rates seen in Nepal. Sustainable training programmes and distribution of neonatal resuscitation equipment are critical priorities in this region.