POST-NATAL SCREENING PROGRAMME
THE PROBLEM
Through the development of the surgical teaching programme HPN found that there is a lack of wider surgical screening for common surgical conditions. In addition, Nepal does not have an established post-natal programme, to check the well-being of neonates and new mothers after delivery.
Childbirth and the weeks after are a pivotal time for Mother and Child across the globe. In the UK, new mothers are given the opportunity to attend their local GP for a '6 to 8 week check'. During this appointment, a GP can examine both the new infant and their mother, provide support and address any queries they may have. It also facilitates screening for certain neonatal conditions that can cause complications in later life - such as heart defects, or eye, hip, and genital problems. Babies can then attend their first immunisations, which are commonly given after the initial baby check.
This is not currently in place in Nepal, meaning mothers and children in rural areas struggle to access healthcare easily - during a time of many potential anxieties and health issues both for the new infant and mother. As a result, neonatal mortality in Nepal stands at 21 in 1000, compared to just 3 in 1000 in the UK.
A SOLUTION: IMPLEMENTATION OF POST-NATAL SCREENING PROGRAMME
HPN is planning to help local teams implement a new 6-8 week check for mothers and children in rural clinics, based on the UK service delivery model in line with NICE guidance.
We are hosting a 2-day teaching programme for existing nurses and community health volunteers to learn the skills required in a 6-8 week check for infants, and how to screen mothers for any extra help or support postpartum. These checks can be performed in appointments prior to infants receiving their 1st immunisations at 8 weeks.
This programme aims to be sustainable, and in line with current current HPN organisational goals, whilst ensuring equitable access to postnatal care for both mother and child in Nepal.
The postnatal check can pick up issues with undescended testes in boys, which can then be appropriately managed by our HPN surgical team - thus linking into our existing surgical programme. It also provides women the opportunity to receive Freedom Kits - reusable, recyclable, material sanitary pads and underwear to help with postnatal menstrual bleeding and disorders.
SUCCESS
In March 2024 HPN carried out the first training programme with 16 midwives and newly graduated nurses. This involved a mixture of hands on demonstrations and theoretical teaching created based on UK practices but adapted and delivered by Nepalese health professionals.
Initial analysis of the feedback from pre- and post-training questionnaires found an increase in mean scores from 61% to 88%. Focus groups further revealed how beneficial participants found the training, with reports of feeling "more confident having done the course". Participants liked having "a system for history taking that translates into clinical care of mothers".
This is just the beginning of the difference HPN aims to make. It is now important to ensure the good work can continue. Whilst participants were open to using the experience to teach others, they were equally aware that "funding is a barrier to sharing their knowledge". With more funding and support HPN hopes to be able to provide further training towards tackling Nepal's neonatal mortality.
