Nepal Community-Based Management of Neonatal Infections: Morang Innovative Neonatal Intervention

Dates: 2003-2006

Country: Nepal

Client(s): Save the Children, USAID

Services: Technical Assistance, Program Development, Training

Technical Expertise: Newborn and Child Health

The Morang Innovative Neonatal Intervention (MINI) Program assisted the Ministry of Health (MOH) and its partners in Nepal to develop and refine the most appropriate roles and protocols for first-level health facilities, community health workers, families, and their communities in promptly identifying and effectively managing neonatal infections. The program was implemented in 21 Village Development Committees of Morang District, serving a total population of about 310,000. Ten thousand births were expected per year in the program area.

The Program tested the hypothesis that implementing a set of activities (training, use of clinical algorithms, early case management, and referral) through the existing health infrastructure, particularly the Community-based Female Community Health Volunteers (FCHVs), will result in an increase in the proportion of sick neonates receiving appropriate treatment. FCHVs weigh newborns, assess sick neonates, and if danger signs of possible severe bacterial infection (PSBI) are present, they initiate treatment with oral cotrimoxazole and facilitate referral to a VHW, MCHW, or a health facility for gentamicin injections. They also conduct follow-up visits and health education.

By June 2006, the main program findings included: 6,611 total births recorded in the intervention area. Among those, 100% received a two month follow-up visit by a FCHV. There were 136 deaths, of which 125 occurred within the first 28 days of life.

FCHVs weigh newborns, a service appreciated by nearly all families, and found that 15% of the babies were low birthweight (LBW), below 2500 grams, within 72 hours of birth. FCHVs made four follow-up visits to over 80% of the LBW babies and their families to counsel on essential newborn care and assess the babies for danger signs.

FCHVs managed 1,490 episodes (23% of newborns) of local bacterial infections, with the most common being umbilical infections (62%), followed by eye (37%) and skin (16%). Fourteen percent of newborns presented with signs of Possible Severe Bacterial Infections (PSBI). Sixty-eight percent presented first to the FCHV, 17% to a VHW or MCHW, and 15% to a government health facility. Ninety percent of parents agreed to treatment with antibiotics and among those, 91% completed the 7-day course of gentamicin injections. Community acceptance of this intervention is high.

A final evaluation was conducted by the Saving Newborn Lives project in September 2006 and results were shared in a dissemination meeting in Kathmandu. The MOH and partners committed to replication and scale-up of a refined package in other Terai districts. USAID, through its bilateral project, Nepal Family Health Program implemented by JSI, supported expansion to the remainder of Morang District.

The MINI Program was followed by MINI II, also implemented for Save the Children through the Saving Newborn Lives initiative.


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