Publications by authors named "Rejina Gurung"
Mistreatment during institutional childbirth is multifactorial and can have a detrimental effect on women's health and future care-seeking behaviour. Understanding its determinants is essential for improving respectful maternity care. This study aimed to explore women's experiences of mistreatment during childbirth in Nepal.
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- The study focuses on the impacts of rising global temperatures, especially how heatwaves threaten pregnant women, prompting the need for tools to assess their knowledge and perceptions of these risks.
- Researchers created and validated a set of 50 questions based on the Health Belief Model, examining aspects like knowledge, perceived vulnerability, and adaptation strategies among pregnant women.
- The results identified three main factors related to pregnant women's perceptions—Severity of heatwave risks, Cues to Action for managing those risks, and their Vulnerability—confirming the tools' reliability for future assessments.
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- Postpartum depression can happen to new moms, especially if they have had a tough time during childbirth or if they were treated badly in the hospital.
- In a study in Nepal, it was found that women who faced mistreatment during childbirth were almost 50% more likely to feel depressed afterward.
- To help new moms feel better, it’s important to provide respectful care during births and check for depression symptoms regularly.
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- The study investigates how ongoing maternal depressive symptoms in the first three months postpartum affect infant neurodevelopment at six months old.
- Researchers followed 1,253 mother-infant pairs and found that 7.5% of mothers experienced persistent depression, and similarly, 7.5% of infants showed neurodevelopmental delays.
- Infants of mothers with persistent depressive symptoms had a much higher risk of neurodevelopmental delay (48.6%) compared to those without (5.1%), indicating a significant negative impact of maternal mental health on infant development.
Background: International guidelines recommend early intervention to all children at risk of cerebral palsy, but targeted screening programs are often lacking in low- and middle-income settings with the highest burden of disease. Smartphone applications have the potential to improve access to early diagnostics by empowering parents to film their children at home followed by centralized evaluation of videos with General Movements Assessment. We explored mothers' perceptions about participating in a smartphone aided cerebral palsy screening program in Kathmandu, Nepal.
View Article and Find Full Text PDFObjective: This study aims to assess the acceptability of a novel technology, MAchine Learning Application (MALA), among the mothers of newborns who required resuscitation.
Setting: This study took place at Bharatpur Hospital, which is the second-largest public referral hospital with 13 000 deliveries per year in Nepal.
Design: This is a cross-sectional survey.
Objectives: To evaluate the feasibility of using the NeuroMotion smartphone application for remote General Movements Assessment for screening infants for cerebral palsy in Kathmandu, Nepal.
Method: Thirty-one term-born infants at risk of cerebral palsy due to birth asphyxia or neonatal seizures were recruited for the follow-up at Paropakar Maternity and Women's Hospital, 1 October 2021 to 7 January 2022. Parents filmed their children at home using the application at 3 months' age and the videos were assessed for technical quality using a standardised form and for fidgety movements by Prechtl's General Movements Assessment.
Background: Improving the healthcare providers (HCP) basic resuscitation skills can reduce intrapartum related mortality in low- and middle-income countries. However, the resuscitation intervention's successful implementation is largely dependent on proper facilitation and context. This study aims to identify the facilitators and barriers for the implementation of a novel resuscitation package as part of the quality improvement project in Nepal.
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- - Worldwide, around 240,000 newborns die each year from congenital birth defects, and poor indoor environments, especially from cooking fuel types, are believed to contribute to these health issues.
- - A study of 66,713 women in Nepal found that 60% used polluting fuels, leading to a higher prevalence of birth defects (5.5 per 1000) compared to cleaner fuels (3.5 per 1000), with adjusted odds showing a 49% increased risk for polluting fuel users.
- - Air ventilation did not significantly impact the odds of congenital birth defects, indicating that the type of cooking fuel is a more critical factor in these health outcomes.
Background: Poor quality of intrapartum care remains a global health challenge for reducing stillbirth and early neonatal mortality. Despite fetal heart rate monitoring (FHRM) being key to identify fetus at risk during labor, sub-optimal care prevails in low-income settings. The study aims to assess the predictors of suboptimal fetal heart rate monitoring and assess the association of sub-optimal FHRM and intrapartum related deaths.
View Article and Find Full Text PDFBackground: We assessed the change in obstetric management after implementation of a quality improvement intervention, the Nepal Perinatal Quality Improvement Package (NePeriQIP).
Methods: The Nepal Perinatal Quality Improvement Package was a stepped-wedge cluster-randomized controlled trial conducted in 12 public hospitals in Nepal between April 2017 and October 2018. In this study, three hospitals allocated at different time points to the intervention were selected for a nested before-after analysis.
Objective: Inadequate adherence to resuscitation for non-crying infants will have poor outcome and thus rationalise a need for real-time guidance and quality improvement technology. This study assessed the usability, feasibility and acceptability of a novel technology of real-time visual guidance, with sound and video recording during resuscitation.
Setting: A public hospital in Nepal.
Background: Poor quality of maternal and newborn care contributes to nearly two million deaths of mothers and their newborns worldwide annually. Assessment of readiness and availability of perinatal care services in health facilities provides evidence to underlying bottlenecks for improving quality of care. This study aimed to evaluate the readiness and availability of perinatal care services in public hospitals of Nepal using WHO's health system framework.
View Article and Find Full Text PDFIntroduction: Adherence to intrapartum fetal heart rate monitoring (FHRM) for early decision making in high-risk pregnancies remains a global health challenge. COVID-19 has led to disruption of routine intrapartum care in all income settings. This study aims to evaluate the implementation of quality improvement (QI) intervention to improve intrapartum FHRM and birth outcome before and during pandemic.
View Article and Find Full Text PDFIntroduction: Trust of women and families toward health institutions has led to increased use of their services for childbirth. Whilst unpleasant experience of care during childbirth will halt this achievement and have adverse consequences. We examined the experience of women regarding the care received during childbirth in health institutions in Nepal.
View Article and Find Full Text PDFBackground: Timely initiation of breastfeeding can reduce neonatal morbidities and mortality. We aimed to study predictors for timely initiation of breastfeeding (within 1 h of birth) among neonates born in hospitals of Nepal.
Method: A prospective observational study was conducted in four public hospitals between July and October 2018.
Article Synopsis
- Stimulation of non-crying neonates after birth with an intact umbilical cord increases the likelihood of spontaneous breathing compared to stimulation with a clamped cord.
- In a study of 3,073 non-crying neonates in Nepal, those with intact cords showed a higher percentage of spontaneous breathing (81.1% vs 68.9%) and required less bag-and-mask ventilation (18.0% vs 32.4%).
- The findings suggest that keeping the cord intact during stimulation may improve outcomes in apnoeic neonates, but further research is needed to confirm these results and address potential confounding variables.
Background: Since the Millennium Development Goal era, there have been several efforts to increase institutional births using demand side financing. Since 2005, Government of Nepal has implemented Maternity Incentive Scheme (MIS) to reduce out of pocket expenditure (OOPE) for institutional birth. We aim to assess OOPE among women who had institutional births and coverage of MIS in Nepal.
View Article and Find Full Text PDFBackground: 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 52 356 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).
Introduction: Iron deficiency (ID) is associated with poor neurodevelopment. We have previously shown that delayed umbilical cord clamping (CC) improves iron stores at 8 months and neurodevelopment at 1 year in term, healthy infants in Nepal.
Objective: The aim of this study was to assess the effects of delayed CC (≥180 s) compared to early CC (≤60 s) on neurodevelopment using the Ages and Stages Questionnaire (ASQ) at age 3 years.
Background: Respectful 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.
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- Postpartum haemorrhage (PPH) is a major cause of preventable maternal deaths, prompting the WHO to recommend uterotonics for all women after childbirth to mitigate PPH risks.
- The EN-BIRTH observational study, conducted in five hospitals across Bangladesh, Nepal, and Tanzania, assessed the coverage and quality of uterotonic administration using real-time data collection methods.
- Findings revealed high observed coverage (> 99%) but discrepancies in women's self-reports (79.5 to 91.7%), along with low accuracy in survey data about the specifics of uterotonic administration, highlighting a significant gap in both data recording and timely administration.
Background: Umbilical cord hygiene prevents sepsis, a leading cause of neonatal mortality. The World Health Organization recommends 7.1% chlorhexidine digluconate (CHX) application to the umbilicus after home birth in high mortality contexts.
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