Neonatal health in Nepal: analysis of absolute and relative inequalities and impact of current efforts to reduce neonatal mortality

Background: Nepal has made substantial progress in reducing under-five mortality and is on track to achieve Millennium Development Goal 4, but advances in neonatal health are less encouraging. The objectives of this study were to assess relative and absolute inequalities in neonatal mortality over time, and to review experience with major programs to promote neonatal health. Methods: Using four nationally representative surveys conducted in 1996, 2001, 2006 and 2011, we calculated neonatal mortality rates for Nepal and for population groups based on child sex, geographical and socio-economic variables using a true cohort log probability approach. Inequalities based on different variables and years were assessed using rate differences (rd) and rate ratios (rr); time trends in neonatal mortality were measured using the annual rate of reduction. Through literature searches and expert consultation, information on Nepalese policies and programs implemented since 1990 and directly or indirectly attempting to reduce neonatal mortality was compiled. Data on timeline, coverage and effectiveness were extracted for major programs. Results: The annual rate of reduction for neonatal mortality between 1996 and 2011 (2.8 percent per annum) greatly lags behind the achievements in under-five and infant mortality, and varies across population groups. For the year 2011, stark absolute and relative inequalities in neonatal mortality exist in relation to wealth status (rd = 21.4, rr = 2.2); these are less pronounced for other measures of socio-economic status, child sex and urban-rural residence, ecological and development region. Among many efforts to promote child and maternal health, three established programs and two pilot programs emerged as particularly relevant to reducing neonatal mortality. While these were designed based on national and international evidence, information about coverage of different population groups and effectiveness is limited. Conclusion: Neonatal mortality varies greatly by socio-demographic variables. This study clearly shows that much remains to be achieved in terms of reducing neonatal mortality across different socio-economic, ethnic and geographical population groups in Nepal. In moving forward it will be important to scale up programs of proven effectiveness, conduct in-depth evaluation of promising new approaches, target unreached and hard-to-reach populations, and maximize use of financial and personnel resources through integration across programs

Impact of the community-based newborn care package in Nepal: a quasi-experimental evaluation

OBJECTIVE To evaluate the impact of the community-based newborn care package (CBNCP) on six essential practices to improve neonatal health. METHODS CBNCP pilot districts were matched to comparison districts using propensity scores. Impact on birth preparedness, antenatal care seeking, antenatal care quality, delivery by skilled birth attendant, immediate newborn care and postnatal care within 48 hours were assessed using Demographic and Health Survey (DHS) and Health Management Information System (HMIS) data through difference-in-differences and multivariate logistic regression analyses. FINDINGS Changes over time in intervention and comparison areas were similar in difference-in-differences analysis of DHS and HMIS data. Logistic regression of DHS data also did not reveal any significant improvement in combined outcomes: birth preparedness, adjusted OR (aOR)=0.8 (95% CI 0.4 to 1.7); antenatal care seeking, aOR=1.0 (0.6 to 1.5); antenatal care quality, aOR=1.4 (0.9 to 2.1); delivery by skilled birth attendant, aOR=1.5 (1.0 to 2.3); immediate newborn care, aOR=1.1 (0.7 to 1.9); postnatal care, aOR=1.3 (0.9 to 1.9). Health providers' knowledge and skills in intervention districts were fair but showed much variation between different providers and districts. CONCLUSIONS This study, while representing an early assessment of impact, did not identify significant improvements in newborn care practices and raises concerns regarding CBNCP implementation. It has contributed to revisions of the package and it being merged with the Integrated Management of Neonatal and Childhood Illness programme. This is now being implemented in 35 districts and carefully monitored for quality and impact. The study also highlights general challenges in evaluating the impacts of a complex health intervention under 'real life' conditions

In situ orientation of fish larvae can vary among regions

Larval coral-reef fishes have good orientation abilities. Through-water orientation of larvae in some species is location-dependent at meso-scales 90% of larvae swam directionally with similar precision and speeds, and with significant among-individual orientation. Yet through-water orientation was easterly at CGBR (72 +/- 30 degrees) and NCRL (87 +/- 20 degrees), and significantly different from NGBR. Over-bottom orientation (i.e. the result of current and larval swimming), measured by GPS at start and end of observing each larva, was weak east-southeasterly at NGBR (116 +/- 40 degrees, p = 0.045), not significantly directional at CGBR, and strongly westerly at NCRL (246 +/- 28 degrees, p = 0.0006), indicating that dispersal of C. atripectoralis is both current-and behaviour-dependent. This is the first report of location-dependent larval fish orientation at a regional scale. This might be an evolutionary response to regional hydrodynamic conditions to limit downstream dispersal

Search for proton emission of the isomeric 10+ state in 54 Ni

9 pags., 7 figs., 1 tab.Several experiments were conducted at the 10 MV Van-de-Graaff tandem accelerator at the Institute of Nuclear Physics, Cologne, to detect proton emission from the isomeric 6457-keV 10 state in Ni. Excitation functions for two fusion–evaporation reactions were measured to maximise the population of the rare two-neutron evaporation channel from a Ni compound nucleus. The search for delayed proton emission was based on the Si (Si , 2 n)Ni reaction at a beam energy of 70 MeV. For this reaction, a cross-section limit for the population of the 10 state in Ni and its proton-decay branch was determined to be σ< 22 nb.Open Access funding provided by Projekt DEAL. We would like to thank the accelerator staff at the University of Cologne for the efforts to deliver heavy-ion beams of excellent quality, as well as the Swedish Research Council (contract VR 2008-4240 and VR 2016- 3969) for financial support

Electric quadrupole moments of the 21+_{1}^{+} states in 100,102,104^{100,102,104}Cd

Using the REX-ISOLDE facility at CERN the Coulomb excitation cross sections for the 0gs+→21+ transition in the β-unstable isotopes 100,102,104Cd have been measured for the first time. Two different targets were used, which allows for the first extraction of the static electric quadrupole moments Q(21+) in 102,104Cd. In addition to the B(E2) values in 102,104Cd, a first experimental limit for the B(E2) value in 100Cd is presented. The data was analyzed using the maximum likelihood method. The provided probability distributions impose a test for theoretical predictions of the static and dynamic moments. The data are interpreted within the shell-model using realistic matrix elements obtained from a G-matrix renormalized CD-Bonn interaction. In view of recent results for the light Sn isotopes the data are discussed in the context of a renormalization of the neutron effective charge. This study is the first to use the reorientation effect for post-accelerated short-lived radioactive isotopes to simultaneously determine the B(E2) and the Q(21+) values