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Background The influence of the safety and security of environments on early childhood development (ECD) has been under-explored. Although housing might be linked to ECD by affecting a child’s health and a parent’s ability to provide adequate care, only a few studies have examined this factor. We hypothesized that housing environment is associated with ECD in sub-Saharan Africa (SSA). Methods and findings From 92,433 children aged 36 to 59 months who participated in Multiple Indicator Cluster Survey (MICS) in 20 SSA countries, 88,271 were tested for cognitive and social–emotional development using the Early Childhood Development Index (ECDI) questionnaire and were thus included in this cross-sectional analysis. Children’s mean age was 47.2 months, and 49.8% were girls. Children were considered developmentally on track in a certain domain if they failed no more than 1 ECDI item in that domain. In each country, we used conditional logistic regression models to estimate the association between improved housing (housing with finished building materials, improved drinking water, improved sanitation facilities, and sufficient living area) and children’s cognitive and social–emotional development, accounting for contextual effects and socioeconomic factors. Estimates from each country were pooled using random-effects meta-analyses. Subgroup analyses were conducted by the child’s gender, maternal education, and household wealth quintiles. On-track cognitive development was associated with improved housing (odds ratio [OR] = 1.15, 95% CI 1.06 to 1.24, p < 0.001), improved drinking water (OR = 1.07, 95% CI 1.00 to 1.14, p = 0.046), improved sanitation facilities (OR = 1.15, 95% CI 1.03 to 1.28, p = 0.014), and sufficient living area (OR = 1.06, 95% CI 1.01 to 1.10, p = 0.018). On-track social–emotional development was associated with improved housing only in girls (OR = 1.14, 95% CI 1.04 to 1.25, p = 0.006). The main limitations of this study included the cross-sectional nature of the datasets and the use of the ECDI, which lacks sensitivity to measure ECD outcomes. Conclusions In this study, we observed that improved housing was associated with on-track cognitive development and with on-track social–emotional development in girls. These findings suggest that housing improvement in SSA may be associated not only with benefits for children’s physical health but also with broader aspects of healthy child development., In a cross-sectional analysis of nationally representative survey data from 20 countries, Yaqing Gao and colleagues investigate associations between housing environment and cognitive and social development in children., Author summary Why was this study done? Sub-Saharan Africa (SSA) had the largest number of children (29.4 million) with low cognitive and/or social–emotional development worldwide in 2010. Housing might be linked to early childhood development (ECD) by affecting a child’s health and a parent’s ability to provide adequate care but is neglected in public health, especially in low- and middle-income countries (LMIC). What did the researchers do and find? We tested the hypothesis that improved housing is associated with on-track development in 2 ECD domains (cognitive and social–emotional). We analyzed data from 88,271 children aged 36 to 59 months in 20 SSA countries collected from nationally representative surveys conducted between 2010 and 2019. Improved housing was associated with 15% higher odds of being developmentally on track in the cognitive domain. Overall, improved housing was associated with on-track social–emotional development in girls but not boys. What do these findings mean? Housing improvement in SSA may be associated not only with benefits for children’s physical health but also with broader aspects of healthy child development. Future work to establish a causal link between housing and ECD and to assess its underlying mechanisms is crucial for the designing of cost-effective ECD interventions in SSA.

Aims: Postnatal care of the newborn is essential in order to reduce neonatal mortality. Nepal has made great efforts to improve maternal and child health by focusing on accessibility and outreach over the past decades. This study aims to examine trends, over the past decade, in levels and equity of facility delivery rates and the provision of newborn care after home delivery in Nepal. Methods: Household-level data from the Demographic Health Surveys (DHS) 2006 and 2011 and the Multiple Indicator Cluster Survey (MICS5) from 2014 performed in Nepal was sourced for the study. Coverage rates of facility delivery and newborn care after home delivery were calculated and logistic regression models were used to ascertain inequity. Results: Home delivery rate dropped from 79.2% in 2006 to 46.5% in 2014, a development showing an inequitable distribution, with a larger share of better-off families shifting to facility delivery. For those who still delivered at home there was an increased rate of early initiation of breastfeeding and adequate temperature control, but only 2.2% of women delivering at home received a home visit by a health professional in the first week of delivery. No inequity in receiving newborn care after home delivery could be detected. Conclusions: There have been significant improvements in facility delivery rates over the last 10 years in Nepal and postnatal care at home has improved. There is, however, an alarmingly low level of home visits during an infant’s first week.

Background: The global burden of stillbirth and neonatal deaths remains a challenge in low-income countries. Training in neonatal resuscitation can reduce intrapartum stillbirth and early neonatal mortality. Previous results demonstrate that infants who previously would have been registered as stillbirths are successfully resuscitated after such training, suggesting that there is a process of selection for resuscitation that needs to be explored. Objective: To compare neonatal resuscitation of low birth weight and normal birth weight infants born at a facility in a low-income setting. Methods: Motion-triggered video cameras were installed above the resuscitation tables at a maternity health facility during an intervention study (ISRCTN97846009) employing the Helping Babies Breathe resuscitation protocol in Kathmandu, Nepal. Recordings were analysed, noting crying, stimulation, ventilation, suctioning and oxygen administration during resuscitation. Birth weight, Apgar scores and sex of the infant were retrieved from matched hospital registers. The results were analysed by chi-square and logistic regression. Results: A total of 2253 resuscitation cases were recorded. Low birth weight infants in need of resuscitation had higher odds of receiving ventilation (aOR 1.73, 95% CI 1.24–2.42) and lower odds of receiving suctioning (aOR 0.53, 95% CI 0.34–0.82) after adjustment for the Helping Babies Breathe intervention, sex of the infant and place of resuscitation within the facility. The rates of stimulation and administration of oxygen were the same in both groups. Conclusions: Low birth weight was associated with more ventilation and less suctioning during neonatal resuscitation in a low-income setting. As ventilation is the most important intervention when the infant does not initiate breathing after birth, low birth weight was not a predictor for the decision to withhold resuscitation. Frequent routine use of suctioning of the lower airways continues to be a problem in the studied context, even after the introduction of the Helping Babies Breathe protocol.

BACKGROUND: Newborns are at the greatest risk for dying during the intrapartum period, including labor and delivery, and the first day of life. Fetal heart rate monitoring (FHRM) and partogram use to track labor progress are evidence-based techniques that can help to identify maternal and fetal risk factors so that these can be addressed early. The objective of this study was to assess health worker adherence to protocols for FHRM and partogram use during the intrapartum period, and to assess the association between adherence and intrapartum stillbirth in a tertiary hospital of Nepal. METHODS: A case-referent study was conducted over a 15-month period. Cases included all intrapartum stillbirths, while 20 % of women with live births were randomly selected on admission to make up the referent population. The frequency of FHRM and the use of partogram were measured and their association to intrapartum stillbirth was assessed using logistic regression analysis. RESULTS: During the study period, 4,476 women with live births were enrolled as referents and 136 with intrapartum stillbirths as cases. FHRM every 30 min was only completed in one-fourth of the deliveries, and labor progress was monitored using a partogram in just over half. With decreasing frequency of FHRM, there was an increased risk of intrapartum stillbirth; FHRM at intervals of more than 30 min resulted in a four-fold risk increase for intrapartum stillbirth (aOR 4.17, 95 % CI 2.0-8.7), and the likelihood of intrapartum stillbirth increased seven times if FHRM was performed less than every hour or not at all (aOR 7.38, 95 % CI 3.5-15.4). Additionally, there was a three-fold increased risk of intrapartum stillbirth if the partogram was not used (aOR 3.31, 95 % CI 2.0-5.4). CONCLUSION: The adherence to FHRM and partogram use was inadequate for monitoring intrapartum progress in a tertiary hospital of Nepal. There was an increased risk of intrapartum stillbirth when fetal heart rate was inadequately monitored and when the progress of labor was not monitored using a partogram. Further exploration is required in order to determine and understand the barriers to adherence; and further, to develop tools, techniques and interventions to prevent intrapartum stillbirth. CLINICAL TRIAL REGISTRATION: ISRCTN97846009 .

Background The majority of infants who die in the neonatal period are born with a low birth weight (LBW

Background Globally, at least 2.65 million stillbirths occur every year, of which more than half are during the antepartum period. The proportion of intrapartum stillbirths has substantially declined with improved obstetric care; however, the number of antepartum stillbirths has not decreased as greatly. Attempts to lower this number may be hampered by an incomplete understanding of the risk factors leading to the majority of antepartum stillbirths. We conducted this study in a tertiary hospital in Nepal to identify the specific risk factors that are associated with antepartum stillbirth in this setting. Methods This case-control study was conducted between July 2012 and September 2013. All women who had antepartum stillbirths during this period were included as cases, while 20 % of all women delivering at the hospital were randomly selected and included as referents. Information on potential risk factors was taken from medical records and interviews with the women. Logistic regression analysis was completed to determine the association between those risk factors and antepartum stillbirth. Results During the study period, 4567 women who delivered at the hospital were enrolled as referents, of which 62 had antepartum stillbirths and were re-categorized into the case population. In total, there were 307 antepartum stillbirths. An association was found between the following risk factors and antepartum stillbirth: increasing maternal age (aOR 1.0, 95 % CI 1.0–1.1), less than five years of maternal education (aOR 2.4, 95 % CI 1.7–3.2), increasing parity (aOR 1.2, 95 % CI 1.0–1.3), previous stillbirth (aOR 2.6, 95 % CI 1.6–4.4), no antenatal care attendance (aOR 4.2, 95 % CI 3.2–5.4), belonging to the poorest family (aOR 1.3, 95 % CI 1.0–1.8), antepartum hemorrhage (aOR 3.7, 95 % CI 2.4–5.7), maternal hypertensive disorder during pregnancy (aOR 2.1, 95 % CI 1.5–3.1), and small weight-for-gestational age babies (aOR 1.5, 95 % CI 1.2–2.0). Conclusion Lack of antenatal care attendance, which had the strongest association with antepartum stillbirth, is a potentially modifiable risk factor, in that increasing the access to and availability of these services can be targeted. Antenatal care attendance provides an opportunity to screen for other potential risk factors for antepartum stillbirth, as well as to provide counseling to women, and thus, helps to ensure a successful pregnancy outcome. Clinical trial registration ISRCTN97846009 (url. www.isrctn.com/ISRCTN97846009)

BACKGROUND: Knowledge-based organizations, such as health care systems, need to be adaptive to change and able to facilitate uptake of new evidence. To be able to assess organizational capability to learn is therefore an important part of health systems strengthening. The aim of the present study is to assess context using the Dimensions of the Learning Organization Questionnaire (DLOQ) in a low-resource health setting in Nepal. METHODS: DLOQ was translated and administered to 230 employees at all levels of the hospital. Data was analyzed using non-parametric tests. RESULTS: The DLOQ was able to detect variations across employee's perceptions of the organizational context. Nurses scored significantly lower than doctors on the dimension "Empowerment" while doctors scored lower than nurses on "Strategic leadership". These results suggest that the hospital's organization carries attributes of a centralized, hierarchical structure that might hinder a progress towards a learning organization. CONCLUSIONS: This study demonstrates that, despite the designing and developing of the DLOQ in the USA and its main utilization in company settings, it can be used and applied in hospital settings in low-income countries. The application of DLOQ provides valuable insights and understanding when designing and evaluating efforts for healthcare improvement.

Background Each year an estimated 10 million newborns require assistance to initiate breathing, and about 900 000 die due to intrapartum-related complications. Further research is required in several areas concerning neonatal resuscitation, particularly in settings with limited resources where the highest proportion of intrapartum-related deaths occur. The aim of this study is to use CCD-camera recordings to evaluate resuscitation routines at a tertiary hospital in Nepal. Methods CCD-cameras recorded the resuscitations taking place and CCD-observational record forms were completed for each case. The resuscitation routines were then assessed and compared with existing guidelines. To evaluate the reliability of the observational form, 50 films were randomly selected and two independent observers completed two sets of forms for each case. The results were then cross-compared. Results During the study period 1827 newborns were taken to the resuscitation table, and more than half of them (53.3%) were noted as not crying prior to resuscitation. Suction was used in almost 90% of newborns brought to the resuscitation table, whereas bag-and-mask ventilation was only used in less than 10%. The chance to receive ventilation with bag-and-mask for a newborn not crying when brought to the resuscitation table was higher for boys (AdjOR 1.44), low birth weight babies (AdjOR 1.68) and babies that were delivered by caesarean section (AdjOR 1.64). The reliability of the observational form varied considerably amongst the different variables analyzed, but was high for all variables concerning the use of bag-and-mask ventilation and the variable whether suction was used or not, all matching in over 91% of the forms. Conclusions CCD camera technique was a feasible method to assess resuscitation practices in this low resource hospital setting. In most aspects, the staff did not adhere to guidelines regarding neonatal resuscitation. The use of bag-and-mask ventilation was inadequate, and suction was given excessively in terms of protocol. Further studies exploring the underlying causes behind the lack of adherence to the neonatal resuscitation guidelines should be conducted. Electronic supplementary material The online version of this article (doi:10.1186/1471-2431-14-233) contains supplementary material, which is available to authorized users.