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Highlights • Unmet need for contraception in Nepal must be addressed broadly through female emancipation and education. • Despite high levels of unmet need for contraception, no major inequities were found. • A special focus on sexual and reproductive health education and provision of family planning for young women and adolescents is needed in Nepal. Abstract Background Providing access to family planning services is a basic component and a cost-effective intervention to reduce maternal mortality worldwide. It is closely linked to women’s decision-making power and female emancipation. Unmet need for family planning is thus an indicator going beyond maternal health with far reaching societal implications. This study examines the level of unmet need for family planning in Nepal and its distribution along structural determinants. Methods Data from the Multiple Indicator Cluster Survey 2014 was utilized for analysis. Prevalence of unmet need for family planning was calculated and logistic regression models used to ascertain inequity. Results A total unmet need for family planning of 40.9% among the 10,688 included women was observed. No major differences between socioeconomic groups could be detected, except for a somewhat higher rate of unmet need among the least educated. Total fertility rate among the women included was 2.59. Contraceptive use among adolescents was alarmingly low, with almost none reporting using any type of contraception. Conclusion The lack of major inequity implies that the high level of unmet need for contraception is a general problem in society and must be addressed broadly. A special focus on education and provision for adolescents is needed in Nepal. [ABSTRACT FROM AUTHOR]

Purpose To describe data of Pediatric Early Warning Score (PEWS) registrations and to evaluate the implementation of PEWS by examining adherence to clinical guidelines based on measured PEWS, and to relate findings to work context. Design and Methods PEWS, as a part of a concept called Early Detection and Treatment-Children (EDT-C) was implemented at three wards at a Children's Hospital in Sweden. Data were collected from the Electronic Patient Record (EPR) retrospectively to assess adherence to guidelines. The Alberta Context Tool (ACT) was used to assess work context among healthcare professionals (n = 109) before implementation of EDT-C. Results The majority of PEWS registrations in EPR were low whereas 10% were moderate to high. Adherences to ward-specific guidelines at admission and for saturation in respiratory distress were high whereas adherence to pain assessment was low. There were significant differences in documented recommended actions between wards. Some differences in leadership and evaluation between wards were identified. Conclusions Evaluation of PEWS implementation indicated frequent use of the tool despite most scores being low. High scores (5–9) occurred 28 times, which may indicate that patients with a high risk of clinical deterioration were identified. Documentation of the consequent recommended actions was however incomplete and there was a large variation in adherence to guidelines. Contextual factors may have an impact on adherence. Practice Implications EDT-C can lead to increased knowledge about early detection of deterioration, strengthen nurses as professionals, optimize treatment and teamwork and thereby increase patient safety for children treated in hospitals. [ABSTRACT FROM AUTHOR]

Problem The ability of health care providers to work together is essential for favourable outcomes in neonatal resuscitation, but perceptions of such teamwork have rarely been studied in low-income settings. Background Neonatal resuscitation is a proven intervention for reducing neonatal mortality globally, but the long-term effects of clinical training for this skill need further attention. Having an understanding of barriers to teamwork among nurse midwives can contribute to the sustainability of improved clinical practice. Aim To explore nurse midwives’ perceptions of teamwork when caring for newborns in need of resuscitation. Methods Nurse midwives from a tertiary-level government hospital in Nepal participated in five focus groups of between 4 and 11 participants each. Qualitative Content Analysis was used for analysis. Findings One overarching theme emerged: looking for comprehensive guidelines and shared responsibilities in neonatal resuscitation to avoid personal blame and learn from mistakes . Participants discussed the need for protocols relating to neonatal resuscitation and the importance of shared medical responsibility, and the importance of the presence of a strong and transparent leadership. Discussion The call for clear and comprehensive protocols relating to neonatal resuscitation corresponded with previous research from different contexts. Conclusion Nurse midwives working at a maternity health care facility in Nepal discussed the benefits and challenges of teamwork in neonatal resuscitation. The findings suggest potential benefits can be made from clarifying guidelines and responsibilities in neonatal resuscitation. Furthermore, a structured process to deal with clinical incidents must be considered. Management must be involved in all processes. [ABSTRACT FROM AUTHOR]

Abstract: Background: There is increasing evidence of an elevated sex ratio at birth (SRB) in many Asian countries, including Vietnam, and that this prenatal gender inequity is related to sex-selective abortion. However, few studies have investigated the relation between the sex of offspring and delivery care utilization. Objective: The aim of the present study was to relate sex of newborns to place and mode of delivery in a province in northern Vietnam. Methods: A population-based surveillance system within the Neonatal Health–Knowledge Into Practice (NeoKIP) project (ISRCTN44599712) recorded all births within eight districts of Quang Ninh province in northern Vietnam from July 2008 to June 2011. Results: In total, there were 22,377 live births within the study area. SRB was 108 boys per 100 girls. There was a large difference in SRB depending on place of delivery, with 94 boys per 100 girls being delivered at home, whereas 113 boys per 100 girls were delivered at a district-level hospital. Cesarean section (CS) rate was 17%, and within the CS group, the SRB was 135:100. Conclusions: We demonstrated an elevated SRB, especially at district hospital level, and that sex of offspring influenced place and mode of delivery. Although mothers to boys were more likely to receive more qualified delivery care, they were at the same time more likely to undergo unnecessary surgery. Correct information to women and family members about CS and stricter implementation of the medical indications for CS are urgently called for. [Copyright &y& Elsevier]

Purpose The aim of this study was to describe healthcare professionals' experience of caring for acutely, severely ill children in hospital in Sweden. Design and Methods Five focus group interviews were conducted with nurses, nurse assistants and physicians comprising a total of 20 participants. Data were analyzed using qualitative content analysis. Results An overall theme emerged that describes healthcare professionals' experiences as: “being in a multifaceted area of tension with paradoxical elements”. The theme is based on three categories: proficiency of the individuals and the team is the fundamental base; interactions are crucial in an area of tension; and wellbeing of the individual is a balance of contradictory emotions. With maintained focus on the ill child, proficiency is the fundamental base, interactions are crucial, and moreover contradictory emotions are described. Conclusions The interplay based on proficiency may influence the assessments and treatments of acutely, severely ill children. Practice Implications Recognizing the multifaceted area of tension with paradoxical elements, practical teamwork exercises, a structured approach, and assessment tools could be a possible way to develop interprofessional team collaboration to improve the care of acutely, severely ill children in order to increase patient safety. [ABSTRACT FROM AUTHOR]