During MINI 1, staff collected 160 reports of neonatal deaths using a standardized verbal autopsy form. The reports were reviewed by 2 senior neonatologists, in Kathmandu, who assigned the cause of death as follows: neonatal infection (combined figure for pneumonia and sepsis) – 46%; birth asphyxia – 32%; complications of prematurity/low birth weight/RDS - 15%; congenital anomalies – 2%; other – 5%. These findings, which confirm that neonatal sepsis/pneumonia accounts for the majority of neonatal deaths in rural Nepal, justify application of the results from MINI 1 to the development of a streamlined model that the MOHP can apply in other districts.

In addition, in order to address the other major causes of neonatal mortality, eg. birth asphyxia and factors related to prematurity and low birth weight, prenatal and natal care must also be strengthened. Currently, 38% of rural women have one antenatal check-up and only 1 in 7 deliveries is attended by a doctor or nurse/midwife¹. Programs to address the other major causes of neonatal mortality will take a much longer time to bring about the desired results, while an immediate impact can be realized by addressing management of neonatal infections, particularly at the community level. 

MOHP Strategy in place to allow Community-based treatment of Neonatal Infections - The National Neonatal Health Strategy, which was finalized in 2004⁴, was designed to establish policies to guide programs to improve pre-natal, delivery and post-natal care practices for women and their neonates. Within the strategy there is “enabling” terminology, to allow community-based management of neonatal infections. It states: “CHWs (Community Health Workers) should be included in pilot projects to identify neonatal infections at home and if successful could be trained to provide this service. This will include home-based treatment with antibiotics such as cotrimoxazole/referral by FCHVs, use of intramuscular injection Gentamicin or other appropriate oral antibiotics by VHWs and MCHWs. Other arrangements for treatment may be considered as well.”  The policy environment is right for moving ahead with this type of intervention.