An integrated community-to-facility approach to saving lives at birth in rural Nepal
Reducing late fetal (1.2 million), maternal (150,000), and early neonatal (1.4 million) deaths remains the most critical global health challenge. Additionally 1.4 million women suffer severe acute morbidities (“near miss”). Development and scaling of innovative approaches to provision of simple cost-effective interventions to improve intrapartum outcomes is needed. Supporting the Government of Nepal and collaborating with JSI Research and Training Institute, Inc., our project will demonstrate the impact of an integrated strategy that includes established and newly emergent interventions on fetal, maternal, and neonatal mortality. A mobile information and communication technologies platform will allow registration and monitoring of pregnant women, and facilitate an innovative community-to-facility approach to providing the interventions. Combined with basic facilities strengthening in emergency care, we expect a) an increase in demand for appropriate care seeking, b) an acceleration in facility delivery rates, and reductions in c) late fetal and early neonatal deaths (due to intrapartum events, preterm birth, infection, hypothermia) and d) severe morbidity and mortality of women (due to eclampsia, intrapartum hemorrhage, obstructed labor). This integrated approach will be applied randomly to half of 44 communities wherein 2040 pregnancies will be enrolled over 1.5 y compared to the other half receiving an existing standard of care package, thus allowing rigorous demonstration of project impact. Our overarching goal is to demonstrate that, compared to control communities, a composite outcome of maternal and perinatal morbidity and mortality in the intervention villages will be reduced by 50%, thereby providing a scalable model for Nepal and beyond.