Nepal lockdown halved health facility births and increased stillbirths
and newborn deaths
Study reveals major COVID-19 collateral impact on maternal care and
neonatal outcomes

Date:
August 11, 2020
Source:
London School of Hygiene & Tropical Medicine
Summary:
COVID-19 response has resulted in major reductions in health
facility births in Nepal and widened inequalities, with
significantly increased institutional stillbirth and neonatal
mortality, according to a new study.



FULL STORY ========================================================================== COVID-19 response has resulted in major reductions in health facility
births in Nepal and widened inequalities, with significantly increased institutional stillbirth and neonatal mortality, according to a new
study in The Lancet Global Health.


==========================================================================
The research was led Dr Ashish KC and Nepal colleagues with Uppsala
University, Sweden, and the London School of Hygiene & Tropical
Medicine. It is the first published study with primary data on the impact
of a COVID-19 lockdown on births in hospital, and measuring stillbirths
and newborn deaths.

Compared to before lockdown, the number of births in the country's health institutions reduced by approximately 49.9% with increased inequality
by ethnicity. Stillbirth rate in the hospitals increased by 50% from 14
per 1,000 total births before lockdown to 21 per 1,000 total births.

Professor Joy Lawn, co-senior author from the London School of
Hygiene & Tropical Medicine, said: "The COVID-19 outbreak has brought unprecedented disruptions to health services, with the risk being highest
in resource-limited countries, and to the most vulnerable. Babies can
die in minutes if there are delays for safe care. This study provided
the first published primary data on the extent of this risk during the
COVID-19 lockdowns. So far we have only had snapshots from surveys
and modelled estimates." Although prioritised as an essential core
health service, some surveys indicate that maternal and newborn health
services are being affected due to COVID-19 restrictions in low-income
and middle-income countries. Both access and quality of care might be deteriorating, risking deaths and reversals of hard-won gains over the
past two decades.

Nepal is one of a small number of low-income countries believed to be on
track for Sustainable Development Goal targets for maternal and newborn
and child health by 2030. Over the last three decades Nepal has reduced maternal mortality by 76%, and newborn mortality by 62%. Future progress
is now threatened, and each day lives are at risk.



==========================================================================
The first case of COVID-19 was detected in Nepal on January 23, 2020. A countrywide lockdown was announced on March 21, 2020, with directives
to frontline health-care providers to prepare for cases, and disruptions
in the health system and more widely, for example to transport systems.

This study involved around 22,000 births in Nepal in nine hospitals
across all seven provinces, including 11% of all births nationally, and
covered 12.5 weeks before the national lockdown and 9.5 weeks during the lockdown. Very detailed data, including observations, were being collected
as part of a national study on improving quality of care at birth.

As well as a halving of the numbers of institutional births, the research
teams found the risk of neonatal death increased more than 3-fold,
from 13 per 1,000 livebirths to 40 per 1,000 livebirths during lockdown.

Joy Lawn said: "The findings suggest that the national lockdown in Nepal
has had a major impact on women and babies through travel restrictions,
fear of going to hospitals due to COVID-19, with more complex cases in facilities, delays and reduced quality of care.

"Preterm birth and caesarean section rates rose, and quality of care also
fell, notably intrapartum fetal heart rate monitoring and breastfeeding
within one hour of birth. One positive finding from our study was that
we did see improvements in hand hygiene practices of health workers
during childbirth." "Undoubtedly countries face very tough choices on
how to combat COVID-19.

However, our findings raise questions on policies regarding
strict lockdowns in low-income and middle-income countries during
outbreaks. Collateral effects seem to be much more severe than the
actual direct effects of SARS-CoV2 infection, especially so for the
most vulnerable in our society, pregnant women and babies. More data
are needed, but even more importantly, more action now to protect
these services." The authors acknowledge limitations of our study,
including that they did not explore the prevalence or the direct impact
of COVID-19 on health outcomes.

None of the women admitted to the hospital were tested for COVID-19,
but the prevalence of COVID-19 among the study population then was likely
to be very low.


========================================================================== Story Source: Materials provided by London_School_of_Hygiene_&_Tropical_Medicine. Note: Content may be edited
for style and length.


========================================================================== Journal Reference:
1. Ashish KC, Rejina Gurung, Mary V Kinney, Avinash K Sunny,
Md Moinuddin,
Omkar Basnet, Prajwal Paudel, Pratiksha Bhattarai, Kalpana Subedi,
Mahendra Prasad Shrestha, Joy E Lawn, Mats Maalqvist. Effect of
the COVID-19 pandemic response on intrapartum care, stillbirth,
and neonatal mortality outcomes in Nepal: a prospective
observational study. The Lancet Global Health, 2020; DOI:
10.1016/S2214-109X(20)30345-4 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/08/200810183926.htm

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