2 research outputs found
The perfect storm: Disruptions to institutional delivery care arising from the COVID-19 pandemic in Nepal
Background The COVID-19 pandemic has led to system-wide disruption of health services globally. We assessed
the effect of the pandemic on the disruption of institutional
delivery care in Nepal.
Methods We conducted a prospective cohort study among
52356 women in nine hospitals to assess the disruption of
institutional delivery care during the pandemic (comparing
March to August in 2019 with the same months in 2020).
We also conducted a nested follow up cohort study with
2022 women during the pandemic to assess their provision
and experience of respectful care. We used linear regression
models to assess the association between provision and experience of care with volume of hospital births and women’s
residence in a COVID-19 hotspot area.
Results The mean institutional births during the pandemic across the nine hospitals was 24563, an average decrease
of 11.6% (P<0.0001) in comparison to the same time-period in 2019. The institutional birth in high-medium volume
hospitals declined on average by 20.8% (P<0.0001) during
the pandemic, whereas in low-volume hospital institutional birth increased on average by 7.9% (P=0.001). Maternity
services halted for a mean of 4.3 days during the pandemic
and there was a redeployment staff to COVID-19 dedicated
care. Respectful provision of care was better in hospitals with
low-volume birth (β=0.446, P<0.0001) in comparison to
high-medium-volume hospitals. There was a positive association between women’s residence in a COVID-19 hotspot
area and respectful experience of care (β=0.076, P=0.001).
Conclusions The COVID-19 pandemic has had differential
effects on maternity services with changes varying by the volume of births per hospital with smaller volume facilities doing better. More research is needed to investigate the effects
of the pandemic on where women give birth and their provision and experience of respectful maternity care to inform
a “building-back-better” approach in post-pandemic period
Respectful maternal and newborn care : measurement in one EN-BIRTH study hospital in Nepal
BackgroundRespectful maternal and newborn care (RMNC) is an important component of high-quality care but progress is impeded by critical measurement gaps for women and newborns. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study was an observational study with mixed methods assessing measurement validity for coverage and quality of maternal and newborn indicators. This paper reports results regarding the measurement of respectful care for women and newborns.MethodsAt one EN-BIRTH study site in Pokhara, Nepal, we included additional questions during exit-survey interviews with women about their experiences (July 2017-July 2018). The questionnaire was based on seven mistreatment typologies: Physical; Sexual; or Verbal abuse; Stigma/discrimination; Failure to meet professional standards of care; Poor rapport between women and providers; and Health care denied due to inability to pay. We calculated associations between these typologies and potential determinants of health - ethnicity, age, sex, mode of birth - as possible predictors for reporting poor care.ResultsAmong 4296 women interviewed, none reported physical, sexual, or verbal abuse. 15.7% of women were dissatisfied with privacy, and 13.0% of women reported their birth experience did not meet their religious and cultural needs. In descriptive analysis, adjusted odds ratios and multivariate analysis showed primiparous women were less likely to report respectful care (beta =0.23, p-value <0.0001). Women from Madeshi (a disadvantaged ethnic group) were more likely to report poor care (<beta>=-0.34; p-value 0.037) than women identifying as Chettri/Brahmin. Women who had caesarean section were less likely to report poor care during childbirth (beta=-0.42; p-value <0.0001) than women with a vaginal birth. However, babies born by caesarean had a 98% decrease in the odds (aOR=0.02, 95% CI, 0.01-0.05) of receiving skin-to-skin contact than those with vaginal births.ConclusionsMeasurement of respectful care at exit interview after hospital birth is challenging, and women generally reported 100% respectful care for themselves and their baby. Specific questions, with stratification by mode of birth, women's age and ethnicity, are important to identify those mistreated during care and to prioritise action. More research is needed to develop evidence-based measures to track experience of care, including zero separation for the mother-newborn pair, and to improve monitoring