Background: The World Health Organization recommends initiation of breastfeeding within 1 hour of birth and exclusive breastfeeding up to 6 months of age. Infant feeding practices, including suboptimal breastfeeding practices, are associated with stunting. Rate of stunting was highest in the Mid-western region and lowest in the Eastern region of Nepal. This study aimed to assess the breastfeeding practices in these two regions, as well as to identify factors associated with partial breastfeeding. Methods: We conducted a health facility-based cross-sectional study in the Mid-western and Eastern regions of Nepal from December 2017 to May 2018. Investigators administered a pre-tested questionnaire among consecutive 574 mother-infant dyads at different levels of health facilities. We dichotomized the breastfeeding pattern to partial breastfeeding and full (exclusive or predominant) breastfeeding. We conducted multivariable logistic regression to identify factors associated with partial breastfeeding within 6 months of age. Results: There were 574 infants included in the study, all of which received at least some breastfeeding. Only 23.2% of infants were exclusively breastfed until 6 months, with 28.2% predominantly breastfed and 48.6% partially breastfed. Partial breastfeeding rate was 52.3% in the Mid-western region and 44.4% in the Eastern region. Breastfeeding was initiated within an hour from birth in 67.2% of infants. One-quarter of infants were given pre-lacteal feed, honey being the commonest. Knowledge of the recommended duration of exclusive breastfeeding was inadequate in 16, and 65% of mothers reported breastfeeding problems in the first 6 months. Firstborn and low birth weight infants had a significantly higher rate of partial breastfeeding. Partial breastfeeding was also higher when infants were not breastfed within 1 hour from birth, mothers reported having breastfeeding-related problems or had inadequate knowledge of the duration of exclusive breastfeeding. Conclusion: Nearly half of the infants were fully breastfed at 6 months of age in Nepal. The rate of partial breastfeeding was higher with inadequate knowledge on duration of exclusive breastfeeding or late initiation of breastfeeding or perceived breastfeeding problems. Hence, programs should address knowledge and practice gaps in breastfeeding practices, particularly among mothers of low birth weight and firstborn infants.

Intrapartum events leading to asphyxia at birth are among the leading causes of neonatal morbidity and mortality in Nepal. In response to this, the Nepal Ministry of Health and Population adopted Helping Babies Breathe (HBB) as a tool to improve neonatal resuscitation competencies. The effectiveness of HBB trainings has been well established. However, challenges remain in maintaining skills over time. Safa Sunaulo Nepal (SSN), with support from Latter-day Saint Charities (LDS Charities) designed an initiative for scaling up newborn resuscitation training and skills maintenance over time. This paper reports on the implementation of the SSN model of newborn resuscitation trainings and skill retention, and the changes in perinatal outcomes that occurred after the program. The program built capacity among facility-based trainers for the scale up and maintenance of resuscitation skills in 20 facilities in Madhesh Province, Nepal. A single external Mentor coached and assisted the facility-based trainers, provided general support, and monitored progress. Prospective outcome monitoring tracked changes in health metrics for a period of 14 months. Data was gathered on the neonatal health outcomes of 68,435 vaginal deliveries and 9,253 cesarean sections. Results indicate decreases in neonatal deaths under 24 hours of life (p<0.001), intrapartum stillbirths (p<0.001), and the number of sick newborns transferred from the maternity unit (p<0.001). During the program, facility-based trainers taught resuscitation skills to 231 medical personnel and supported ongoing skill retention. The SSN model for newborn resuscitation training and skills retention is a low-cost, evidence-based program focusing on facility-based trainers who are mentored and supported to scale-up and sustain resuscitation skills over time. Findings from the report are suggestive that the model had a substantial influence on critical neonatal outcomes. Future programs focused on improving neonatal outcomes may benefit by incorporating program elements of SSN model.

Introduction: Disrespect and abuse of women during maternity care in health institutions can significantly impact women’s willingness to seek out life-saving maternity care however; evidence suggests prevailing disrespectful maternity care worldwide. This study aims to identify perceived disrespect and abuse during labor and delivery among postnatal women delivering at Bheri Hospital, Nepal. Methods: A cross-sectional study was conducted among 422 purposively selected women admitted in the postnatal ward of Bheri Hospital, Nepal, from February to March 2020. Face-to-face interview was conducted for data collection after obtaining informed written consent. A semi- structured questionnaire consisting of demographic information and a pre-validated Respectful Maternity Care (RMC) tool was used. The information was then checked, coded, and entered in SPSS for descriptive and inferential analysis. Results: In this study, most of the participant perceived high respectful maternity care which included high friendly care, high abuse free care and high discrimination free care however only half of the participants experienced timely care. As compared to Highly-Priviledged ethnic group, Madhesi/ dalit and other minority groups reported of experiencing low respectful maternity care. Also, those who had monthly income of more than NRs. 20000 and who had more than two living children were found to have experienced low respectful care as compared to those with lesser income and less than two children respectively. Conclusion: This study concludes that though overall respectful maternity care is high, low timely care has been reported as compared to other components of Respectful maternity care i.e. friendly care, abuse-free care, and non- discriminatory care. Delayed care provided may negatively impact the delivering women to use the services in future or refer others for the same. Thus, appropriate interventions to provide timely care to delivering women must be instituted.

Background: Intrapartum events leading to asphyxia at birth is one of the leading causes of neonatal morbidity and mortality in Nepal. In response to this, the Nepal Ministry of Health and Population adopted Helping Babies Breathe (HBB) as a tool to improve neonatal resuscitation. The effectiveness of HBB trainings in developing newborn resuscitation knowledge and skills of service providers have been well established. However, challenges remain in maintaining skills over time. Safa Sunaulo Nepal (SSN), with support from LDS Charities designed an initiative for scaling up newborn resuscitation training and maintaining skills over time. This paper reports on the implementation of SSN’s model of newborn resuscitation trainings and skill retention, and changes in perinatal outcomes that occurred during the program. Methods: The program capacitated facility-based trainers for scale up and maintaining resuscitation skills in 20 facilities in Madhesh Province, Nepal. A single external mentor coached and assisted the facility-based trainers, provided general support, and monitored progress. Prospective outcome monitoring tracked changes in health metrics for a period of 14 months. To analyze changes over the time, the neonatal mortality, morbidity, and stillbirths at the baseline (first two months) of the program was compared with the endline (last two months) measures. Results: Data was gathered on neonatal health outcomes of 68,435 vaginal deliveries and 9,253 cesarean sections. Results indicate decreases in <24 hours neonatal deaths (p<0.001), intrapartum stillbirths (p<0.001), and number of sick newborns transferred from the maternity unit (p<0.001). During the program, facility-based trainers taught resuscitation skills to 231 medical personnel and supported skill retention. Conclusions: SSN’s model is a low-cost, evidence-based program focusing on facility-based trainers, who are mentored and supported to scale-up and sustain resuscitation skills over time. Findings from the report are suggestive that the model had a substantial influence on critical neonatal outcomes. Future programs focused on improving neonatal outcomes may benefit by incorporating program elements of SSN model.

A significant proportion of neonatal mortality, a major public health challenge in low- and middle-income countries, can be attributed to intrapartum-related hypoxic events. This study seeks to assess the determinants of health care providers’ competence in providing newborn resuscitation. A cross-sectional survey of 154 health facilities in Nepal was done. This nested study evaluated the newborn resuscitation knowledge and skills of 462 health care providers by individually assessing a delivery using a 22-item clinical practice observation tool and administering the standard 18-item Helping Babies Breathe Knowledge Check Significant predictors of provider knowledge included: province (0.085 points higher in Bagmati province, p=0.018); mean availability of essential utilities and resuscitation aids (0.173 points, p<0.001 and 0.187, p= 0.02 respectively); participation in – Latter-day Saint Charities – Safa Sunaulo Nepal (LDSC/SSN) newborn resuscitation training, scale-up and skill retention program (0.676 units higher, p<0.001); and qualifications (0.136 points higher among health providers with Bachelor of Nursing degree, p<0.001, 0.072 points higher among providers with Masters in Nursing degree, p= 0.010 and 0.110 units higher among providers with Senior Auxiliary Nursing Midwife degree,, p=0.001). Significant factors associated with resuscitation skill included province (0.056 units higher in province 1, p= 0.015 and 0.037 units higher in Sudurpaschim province, p=0.034); delivery caseload (0.066 units higher mean skill score in health facilities with average monthly delivery of more than 120, p= 0.011); availability of newborn resuscitation practice aids (0.093 units higher score in health facilities with resuscitation practice aids, p= 0.008); and participation in LDSC/SSN newborn resuscitation training, scale-up and skill retention program (0.968 units, p< 0.001). Participation in the LDSC/SSN’ skill retention program was the best predictor of newborn resuscitation knowledge and skills. The LDSC/SSN model of newborn resuscitation training, scale up and skill retention could be one potential cost-effective model to address gaps in resuscitation knowledge and skills among service providers.

Background: Nepal’s diverse geography creates significant challenges for healthcare accessibility, particularly for neonatal care. Rural areas, especially in the mountainous regions, face severe healthcare gaps due to isolation, inadequate infrastructure, and a shortage of skilled staff. Strengthening healthcare in these underserved regions is essential to reducing neonatal mortality. Methods: A comprehensive literature search identified studies on neonatal mortality and interventions, particularly Helping Babies Breathe (HBB), analyzed using a narrative synthesis approach. The review examined disparities in neonatal health outcomes, regional differences, and barriers to healthcare access. Findings: The review identified key themes related to healthcare disparities, neonatal mortality, and birth outcomes in Nepal's remote regions. Geographical isolation, inadequate healthcare infrastructure, and cultural barriers contribute to persistently high neonatal mortality, particularly in mountainous areas such as Jumla and Dolpa, where rates exceed 60 per 1,000 live births. HBB has shown a significant impact, reducing neonatal mortality by up to 60% when effectively implemented. However, infrastructural gaps, lack of emergency transport, and the uneven distribution of skilled birth attendants (SBAs) remain critical challenges. Addressing these disparities requires expanded training, increased availability of neonatal resuscitation equipment, and culturally sensitive healthcare strategies. Recommendations: Future research should explore sustainable neonatal resuscitation training, telemedicine support, and emergency referral systems to improve neonatal survival in remote Nepal. Further studies on healthcare infrastructure gaps and policy-driven interventions are needed to enhance maternal and newborn care. Conclusions: While HBB and other neonatal interventions have demonstrated success in reducing neonatal mortality, their impact is limited by persistent disparities in healthcare infrastructure, workforce availability, and geographic inaccessibility. To achieve sustainable reductions in neonatal mortality, a multi-faceted approach combining expanded SBA training, improved emergency healthcare infrastructure, and community-based interventions is essential.