Reducing Neonatal Mortality in Nepal’s Remote Regions: A Narrative Review of Challenges, Disparities, and the Role of Helping Babies Breathe (HBB)
Abstract
:1. Introduction
1.1. Geographical Barriers to Healthcare Access
1.2. Healthcare Infrastructure and Access in Nepal
1.3. Neonatal Mortality and Health Disparities in Remote Nepal
2. Methods
2.1. Search Strategy and Study Selection
- ‘neonatal mortality’ OR ‘infant mortality’.
- ‘neonatal resuscitation’ OR ‘Helping Babies Breathe (HBB)’.
- ‘newborn care’ OR ‘birth outcomes’.
- ‘healthcare disparities’ OR ‘healthcare access’.
- ‘skilled birth attendants’ OR ‘healthcare workers’.
- ‘remote regions’ OR ‘rural healthcare’ OR ‘resource-limited settings’.
- ‘geographical barriers’ OR ‘terrain’ OR ‘infrastructure challenges’.
- ‘Nepal’ AND ‘hilly regions’ OR ‘mountainous regions’.
- ‘antenatal care’ OR ‘delivery practices’.
- ‘cultural barriers’ OR ‘socio-cultural factors’ OR ‘ethnic groups’.
- ‘healthcare interventions’ OR ‘healthcare programs’.
Inclusion and Exclusion Criteria
- Quantitative and qualitative studies;
- Randomized controlled trials;
- Observational studies.
2.2. Data Extraction and Analysis
- Study design and population;
- Neonatal mortality rates and birth outcomes;
- Healthcare access and service availability;
- Effectiveness of interventions;
- Geographical and cultural factors influencing neonatal healthcare.
2.3. Narrative Synthesis
2.3.1. The Four-Stage Narrative Synthesis Framework
- Preliminary synthesis;
- Exploring relationships within and between studies;
- Critical appraisal of studies;
- Synthesis and presentation of findings.
2.3.2. Preliminary Synthesis
2.3.3. Exploring Relationships Within and Between Studies
- Study type (qualitative vs. quantitative);
- Geographical region (hilly vs. mountainous);
- Type of intervention (e.g., HBB, SBA programs, etc.).
2.3.4. Critical Appraisal of Studies
- Study design and methodology;
- Sample size and representativeness;
- Intervention effectiveness and bias evaluation.
2.4. Synthesis and Presentation of Findings
- Regional disparities in neonatal mortality and birth outcomes;
- Impact of neonatal resuscitation programs such as HBB;
- Infrastructure and resource gaps in neonatal healthcare;
- Geographical barriers to healthcare access.
3. Results
- Regional disparities in neonatal mortality and birth outcomes;
- The impact of neonatal resuscitation programs such as HBB, and infrastructure and equipment gaps in neonatal healthcare;
- Geographic barriers to healthcare access.
4. Discussion
5. Recommendations
6. Limitations
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Author Year | Study Design | Study Population | Key Themes | Findings | CASP Score [26] |
---|---|---|---|---|---|
Acharya et al. (2021) [20] | Cross-sectional | 457 health facilities across Nepal | Healthcare infrastructure, facility readiness, emergency obstetric care | Hospitals had higher neonatal care readiness. Only 16.1% offered assisted vaginal birth; 10% provided anticonvulsants. Readiness was linked to staffing levels, 24 h service, and newborn death review. | Moderate risk of bias due to self-reported facility readiness assessments |
Bhattarai et al. (2022) [27] | Cross-sectional. | 1386 term singleton births from 4 hospitals in eastern Nepal | Geographic disparities, birth weight, maternal factors | Low birth weight was more prevalent in hilly regions (6.6%). Dalit ethnicity, low maternal age, and higher antenatal visits associated with hilly-region births. | Low risk; large dataset but limited causal inferences |
Cao et al. (2021) [2] | Spatial analysis | 5553 public health facilities, 2020 population data | Healthcare access, geographic barriers | A total of 92.54% of the population accessed facilities within 15 min via motorized transport. Accessibility declined for higher-level facilities. Recommended new health centers in underserved areas. | Moderate risk due to reliance on modeled transport data |
Choulagai (2013) [17] | Cross-sectional | 2481 women who gave birth in last 12 months in three districts | Skilled birth attendants, barriers to healthcare access | Barriers included distance (45%) and transport issues (21%). A total of 48% used SBAs. Antenatal care improved SBA utilization. | Low risk; strong sample representation but lacks qualitative depth |
Ghimire (2019) [6] | Demographic health survey analysis | 23,335 pregnancies from Nepal Demographic Health Survey | Neonatal mortality trends, regional disparities | Perinatal mortality rate was 42 per 1000 births. Higher mortality in mountainous regions, younger mothers, poor sanitation. | Low risk; robust dataset but lacks intervention-specific data |
Kaphle et al. (2013) [22] | Qualitative | 25 pregnant/postnatal women, 16 healthcare/community stakeholders in Mugu | Cultural barriers, birth practices | Animal-shed births preferred due to spiritual beliefs, leading to neonatal risks. Cultural beliefs conflicted with medical advice. | Moderate risk due to small sample size and subjective reporting |
Karki and Kittel (2019) [7] | Mixed-methods | 12,287 people from Dolpa District | Neonatal mortality, cultural influences, healthcare access | Neonatal mortality rate was 67 per 1000. Cultural mistrust of modern medicine and poor health infrastructure led to increased deaths. | Moderate risk; strong sample but relies on retrospective data |
Kc et al. (2017) [28] | Secondary analysis | Women aged 15–49 from Nepal Demographic and Health Surveys (2001, 2006, 2011, 2016) | Neonatal mortality trends, socioeconomic disparities | Neonatal mortality decreased between 2001 and 2016, but disparities widened between wealth quintiles. Tetanus vaccination status, maternal education, and household conditions were key predictors of neonatal mortality. | Low risk; robust dataset but limited ability to analyze causal relationships |
Khanal et al. (2024) [15] | Prospective cohort | 735 mother–infant pairs in western Nepal | Home births, healthcare utilization | Total of 11.8% had home births. Low antenatal care increased likelihood of home birth. Higher wealth correlated with hospital births. | Low risk; strong methodology but lacks long-term neonatal tracking |
Khatri et al. (2022) [14] | Cross-sectional | 901 antenatal care facilities and 454 perinatal service providers | Healthcare infrastructure, service quality | Structural quality scores were higher for private facilities; government-run facilities in rural areas showed poor readiness for maternal and newborn care. | Moderate risk; self-reported facility assessments limit objectivity |
Maru et al. (2017) [29] | Pre-post intervention | 210 postpartum women in rural Nepal | Emergency obstetric care, birth facility utilization | Institutional birth rates rose from 30% to 77% after CEmONC introduction. Availability improved birth planning and safety perceptions. | Low risk; rigorous comparison but limited to one hospital area |
Naresh et al. (2022) [21] | Prospective observational | 18 health facilities assessing 49,809 births | Newborn resuscitation, HBB | HBB training reduced neonatal deaths and birth asphyxia. Skill retention remained high over 24 months. | Low risk; large dataset, but results may not generalize to non-participating regions |
Pandey et al. (2023) [19] | Cross-sectional | 804 health facilities in Nepal | Emergency obstetric care, facility readiness | Service availability for neonatal care remains inadequate. Only 43.7% of facilities met Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) standards. | Moderate risk due to facility-reported data |
Paudel et al. (2018) [16] | Qualitative | 42 interviews with women who experienced perinatal deaths and 20 interviews with healthcare workers | Healthcare system barriers, perinatal mortality | Poor governance, lack of community engagement, and weak health system accountability contribute to high perinatal mortality in remote villages. | Moderate risk; small sample limits generalizability |
Schoenhals et al. (2017) [30] | Cross-sectional | 122 women who gave birth in the past 24 months in Solukhumbu District | Maternal–newborn health practices | Only 26% of births occurred in health facilities, with 70% at home. Limited access to skilled birth attendants contributed to neonatal complications. | Moderate risk; small sample size but relevant to high-altitude populations |
Shrestha and Jung (2023) [13] | Quasi-experimental | Rural Nepalese children from Nepal Living Standards Survey data | Healthcare reform, gender-based disparities | Healthcare reform reduced infant mortality for boys but had no significant effect on girls, suggesting persistent societal gender biases in healthcare access. | Moderate risk; reliance on secondary data may not capture all confounders |
Singh and Shankar (2023) [31] | Cross-sectional | 500 health assistants registered with Nepal Health Professional Council | CPR knowledge among healthcare workers | Only 12.8% had CPR training; none had performed CPR. Training gaps highlight urgent need for competency development. | Low risk; strong methodology but limited to one profession |
Tamang et al. (2021) [18] | Descriptive cross-sectional | 31 state-run health facilities in Jumla District | Facility preparedness, medicine availability | Many facilities lacked essential neonatal medicines and transport services. Emergency preparedness was inadequate in most centers. | Moderate risk; self-reported data may limit reliability |
Thapa et al. (2000) [8] | Community-based retrospective | 3007 live-born children from 772 mothers in Jumla, Nepal | Animal-shed births, neonatal mortality | Neonatal mortality was significantly higher for births occurring in animal sheds compared to homes. Lack of hygiene and medical care contributed to higher risk. | Moderate risk; older dataset but relevant to cultural birth practices |
Thomas et al. (2022) [32] | Cross-sectional | 487 households and 19 health facilities in Solukhumbu District | Facility readiness, SBA availability | Only 35.7% of births occurred in health facilities. Lack of trained obstetric and neonatal staff hindered service readiness. | Low risk; large sample, but self-reported barriers may introduce bias |
Tuladhar (2024) [33] | Cross-sectional | Survey data from 2015 and 2021 assessing facility readiness | Neonatal service provision, healthcare trends | By 2021, only 2.2% of facilities stocked all essential neonatal medicines. Readiness for neonatal care remained critically low, particularly in rural areas. | Moderate risk; government survey data may not reflect all local disparities |
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Kain, V.J.; Dhungana, R.; Dhungana, A. Reducing Neonatal Mortality in Nepal’s Remote Regions: A Narrative Review of Challenges, Disparities, and the Role of Helping Babies Breathe (HBB). Pediatr. Rep. 2025, 17, 48. https://doi.org/10.3390/pediatric17020048
Kain VJ, Dhungana R, Dhungana A. Reducing Neonatal Mortality in Nepal’s Remote Regions: A Narrative Review of Challenges, Disparities, and the Role of Helping Babies Breathe (HBB). Pediatric Reports. 2025; 17(2):48. https://doi.org/10.3390/pediatric17020048
Chicago/Turabian StyleKain, Victoria Jane, Ranjan Dhungana, and Animesh Dhungana. 2025. "Reducing Neonatal Mortality in Nepal’s Remote Regions: A Narrative Review of Challenges, Disparities, and the Role of Helping Babies Breathe (HBB)" Pediatric Reports 17, no. 2: 48. https://doi.org/10.3390/pediatric17020048
APA StyleKain, V. J., Dhungana, R., & Dhungana, A. (2025). Reducing Neonatal Mortality in Nepal’s Remote Regions: A Narrative Review of Challenges, Disparities, and the Role of Helping Babies Breathe (HBB). Pediatric Reports, 17(2), 48. https://doi.org/10.3390/pediatric17020048