Key Practice Indicators for Hypothermia Management for Neonates in Rural Nepal
Abstract
In rural Nepal, neonatal hypothermia is a common complication due to lack of proper infrastructure and resources at birthing centers. The purpose of this research study is to examine the common medical practices incorporated in Nepal for prevention of hypothermia during the neonatal period. The study took place in Nuwakot, Nepal from June 2022 to June 2023, with surveys conducted on auxiliary nurse midwives from various birthing clinics in 5 different communities. Within these 5 communities surveyed, each birthing center (hospital, health post, home) gave a priority ranking of 1 (most important) to 14 (least important) for newborn temperature management procedures. Findings revealed that hospitals and health posts prioritized the same procedures except for procedures ranked 8 and 9, where less than 50% of health posts agreed with the hospitals. Home births presented significant variation in the ranking of each procedure, with exception to procedures ranked 1-3 and 12-13, which were similar in ranking to the hospitals and health posts. All home birth surveys explained the reason for their ranking variation as due to geographical remoteness. Among all birthing centers, procedures ranked 1-7 and 10-14 were prioritized the same for greater than 50% of surveys. However, for procedures ranked 8 and 9, less than 50% agreement was observed overall. When neonates were found to be cold, all clinics utilized kangaroo mother care as treatment. Overall, neonatal temperature management practices in rural Nepal were consistent across hospitals and health posts, with notable variation in home births.
Table 1. Summary rank of newborn temperature management procedures at each birthing center. Parentheses denote how many of the 5 surveys agreed on the rank of that procedure. No parentheses mean the majority of surveys at that birthing location agreed on the ranking for that procedure.
Birthing centers surveyed within each of the 5 communities
Hospital
Health Post
Homebirth
Warm delivery Room free from drafts
1
1
1
Immediate and thorough drying of the infant
2
2
2
Wrapping the infant in a dry towel
3
3
3
Weighing the infant while wrapped in a towel
4
4
4 (2/5)
Placing a hat on the infant
5
5
5 (2/5)
Covering the baby and mother together (Kangaroo Mother Care)
6
6
6 (2/5)
Initiation of breastfeeding within 1 hour
7
7
7 (2/5)
Delaying a bath until 6 hours after birth
8
8 (2/5)
8 (0/5)
Only using warm water for bathing
9
9 (2/5)
9 (2/5)
Temperature check 1 hour after birth
10
10
10 (0/5)
Clean warm blankets available for deliver
11
11
11 (1/5)
Resuscitation table with radiant heat source
12
12
12
Low-reading infant thermometer
13
13
13
Heated, water filled mattress
14
14
14 (2/5)