Sustaining progress in maternal and child health in Nepal

Abstract

www.thelancet.com Vol 385 June 27, 2015 2573 3 Kamar N, Bendall R, Legrand-Abravanel F, et al. Hepatitis E. Lancet 2012; 379: 2477–88. 4 Shrestha A, Lama TK, Karki S, et al. Hepatitis E epidemic, biratnagar, Nepal, 2014. Emerg Infect Dis. 2015; 21: 711–13. 5 Teshale EH, Howard CM, Grytdal SP, et al. Hepatitis E epidemic, Uganda. Emerg Infect Dis 2010; 16: 126–29. 6 United Nations. Nepal—Severity of Districts in term of the earthquake intensity area. http:// un.org.np/sites/default/fi les/Serveriity%20 of%20Areas_0.pdf (accessed June 11, 2015). 7 Zhu FC, Zhang J, Zhang XF, et al. Effi cacy and safety of a recombinant hepatitis E vaccine in healthy adults: a large-scale, randomised, double-blind placebo-controlled, phase 3 trial. Lancet 2010; 376: 895-902. district and 85% in Dhading district, disrupting antenatal, delivery, and postnatal care in the catchment areas. Latest information from the Family Health Division, Nepal, confi rmed that 19 out of 21 birthing centres in Dolakha district and 18 out of 21 birthing centres in Sindhupalanchok district are nonoperational. The Nepal Prime Minister announced that relief, rehabilitation and reconstruction will be the government’s priority, which implied possible diversion of the limited health budget to these areas. Evidence from previous disasters in the world have shown a decrease in access and use of prenatal care, with increased rates of miscarriage, premature birth, intrauterine growth, low birthweight, and unwanted pregnancies in the aftermath of disaster. Interruption of breastfeeding practice is a major risk factor for adverse infant health. For example, after the 2006 earthquake in Indonesia, increase in formula feeding from 32% to 43% was associated with a higher incidence of childhood diarrhoea. This situation will be replicated in Nepal unless unregulated use and donation of infant formula are discouraged. The network of outreach clinics should be reinstated, and skilled health workers should be encouraged to attend home deliveries while birthing centres are being rebuilt. The high rate of routine immunisation must be preserved at >90%. As long as the cold chain is maintained, this is feasible since immunisations are mostly done in outreach clinics which require little infrastructure support.