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Where to invest in neonatal survival programs in Nepal? A modelling study using
Lives Saved Tool through scaling key interventions
#MMPMID41343469
Khanal GN
; Giri N
; Jha D
; Chaulagain DR
PLoS One
2025[]; 20
(12
): e0337331
PMID41343469
show ga
BACKGROUND: Neonatal survival remains a major public health priority in many low
and middle-income countries including Nepal, where the neonatal mortality rate
(NMR) is 21 per 1,000 live births. To improve the neonatal health outcomes, the
World Health Organization (WHO) recommends scaling up coverage of quality
antenatal care (ANC), skilled care at birth, immediate essential newborn care and
resuscitation, postnatal care for mother and newborn, and specialized care of
small and sick newborns. In this context, we aimed to estimate the potential
impact of achieving the coverage targets for 35 interventions, identified as
monitoring indicators under Nepal's Every Newborn Action Plan (NENAP), on
neonatal survival in Nepal by 2035. METHODS: We used the Lives Saved Tool (LiST)
to estimate the number of neonatal deaths that could be prevented by 2035 if
target intervention coverage level is achieved, starting from 2025 baseline
values. Baseline data were drawn from demographic and health (DHS) survey and
multiple indicator cluster survey (MICS). Where survey data were unavailable,
proxy estimates were derived from available literatures to establish the baseline
levels. RESULTS: By 2035, achieving the target coverage level could save an
estimated 8,126 neonatal lives compared to the 2025 baseline. This achievement
would reduce the NMR to about 14 per 1,000 live births and avert an additional
5,977 child deaths and 358 maternal deaths. More than two-third (70.4%) of
neonatal lives saved would be attributable to four priority interventions:
neonatal resuscitation (36.0%), promotion of breastfeeding practices (11.8%),
case management of neonatal sepsis (11.7%) and case management of premature
babies (10.9%). At this coverage level, approximately 26.9% of deaths due to
prematurity, 17.9% from sepsis, and 16.1% from diarrhoea could be prevented.
CONCLUSION: Nepal must prioritize highly effective interventions: neonatal
resuscitation, breastfeeding, management of neonatal sepsis and case management
of premature babies to accelerate progress towards the NENAP target. Our analysis
indicates that achieving the specific coverage targets of 35 NENAP interventions
could reduce the NMR to 14 per 1,000 live births which fall short of the NENAP
targets of reducing NMR to 11 per 1,000 live births by 2035. Strengthening
special newborn care unit (SNCU) in line with WHO standard is critical to
improving the quality of care for small and sick newborns (SSNB) in health
facilities. While strengthening newborn resuscitation and SNCU services will
substantially reduce NMR, attaining the NENAP targets will ultimately require
comprehensive health system reforms and effective coverage of other maternal and
newborn interventions.
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