Nepal has successfully reduced under-five mortality and neonatal mortality through various programs. About two in five neonatal deaths occur on the first day of life, and over eight in ten in the first week. The most common causes of neonatal death are sepsis, birth asphyxia, hypothermia, low birth weight, and prematurity. National programs addressing maternal and child health include the Safe Motherhood Program, Integrated Management of Childhood Illness, bi-annual vitamin A supplementation, and immunization. Strategies to further reduce mortality focus on birth preparedness, institutional delivery, and expanding emergency obstetric care. Major challenges include inadequate skilled birth attendants, poor quality of care, and lack of funding and infrastructure especially for

1. Anil Regmi
Medical Student

2.  Nepal has been successful in achieving millenium
development goal (MDG) 4 of reducing the
under-five mortality rate (U5MR) by two-thirds
from the level in 1990
 about two in five neonatal deaths occur on the
first day after birth
 more than 8 out of 10 neonatal deaths occurring
in the first week of life
 most common causes of neonatal mortality are
neonatal sepsis, birth asphyxia, hypothermia, low
birth weight, and prematurity-related conditions
 Whereas for under 5 mortality is due to diarrhea,
pneumonia, malnutrition, malaria.

3.  National Safe Motherhood Program (NSMP).
 Community-Based Integrated Management of
Childhood Illness (CB-IMCI).
 Bi-annual supplementation of Vitamin A.
 National Program on Immunization.
 Community-Based Newborn Care Program
(CB-NCP)

4. Strategies:
 Promoting birth preparedness and
complication readiness including awareness
raising and improving the availability of
funds, transport and blood supplies.
 Encouraging for institutional delivery.
 Expansion of 24-hour emergency obstetric
care services (basic and comprehensive)
at selected public health facilities in every
district.

5. Major Activities:
1. Birth Preparedness Package and MNH Activities
at Community Level
2. Rural Ultra Sound Program
3. Uterine Prolapse
4. Human Resource
5. Emergency Referral Fund
6. Safe Abortion Services
7. Aama Program
 Safe Delivery Incentive Program (SDIP).
 Free institutional delivery care.
 Incentive to health worker for home delivery and
 Incentive to women for 4ANC visits

6.  Initiated from Mahottari district in 1997 as
IMCI
 In 1999 merged with CBAC to be CB-IMCI.
 In FY 2009/2010 CB-IMCI covers all 75
districts.
 It is a program integrated package of child
survival intervention and address major
illness like, pneumonia, diarrhea, measles,
malaria and malnutrition.

7.  Nepal's national vitamin A program, started in a
few districts in 1993.
 In 2003 its coverage became nationwide.
 Given to all children 6 to 60 months of age.
 Vitamin ‘A’ campaign held every year in the
second week of April is being held in the first
week of March.
 Dose:
6month-1year: 1lakh IU
1year-5year: 2lakh IU
 Recently deworming is done along with Vitamin A
supplementation.

8.  World Health organization established a program called
Expanded Program on Immunization (EPI) in 1974.
 In Nepal started in1979 in three districts and was expanded
to all 75 districts by 1989.

9.  It has been developed in 2007 with the goal to
improve the health and survival of newborn babies.
Interventions Included in the Package
 Behavior Change Communication (BCC)
 Promotion of institutional delivery and clean delivery
practices in case of home deliveries
 Postnatal care
 Community case management of pneumonia/
Possible Severe Bacterial Infection (PSBI)
 Care of LBW newborns
 Prevention and management of hypothermia
 Recognition of asphyxia, initial stimulation and
resuscitation of newborn baby

10. Policy guidelines have been developed, health
workers have been trained, a logistics system has
been established, and services are available from
service outlets. However,
 inadequate number of skilled service providers
 service providers with poor skills,
 poor coverage and quality of care in available
services,
 poor and fragile system of logistics procurement
and its supply chain management.

11. MOH has not yet issued any guidelines for the
management of preterm babies.
Further more,
 lack of appropriate policies and strategic
guidelines,
 funding gaps,
 poor infrastructure,
 and logistics as well as inadequate
information
 inadequate referral links
 poor infection prevention

12.  Less referral
 lower or inappropriate use of partographs in
the intra-partum period
 socio-cultural differences
 The poor infrastructure development of
Neonatal Intensive Care Units (NICU)
 limited access to NICU services
 Although there is free delivery service
provided by MOH, but one have to pay for
inpatient newborn care services in all
hospitals.

13. Under-5 mortality rate (U5MR), 1990 142
Under-5 mortality rate (U5MR), 2012 42
U5MR by sex 2012, male 44
U5MR by sex 2012, female
2015 (UN)
39
35.8
Infant mortality rate (under 1), 1990 99
Infant mortality rate (under 1), 2012
2015 (UN)
34
29.4
Neonatal mortality rate 2012
2015 (UN)
24
22.2

14. Nepal:
 NMR: 22
 IMR: 29
 U5MR: 35
India:
 NMR: 28
 IMR: 39
 U5MR: 52
USA:
 NMR: 4
 IMR: 6
 U5MR: 11

15. THANK YOU!!!