{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T01:34:45Z","timestamp":1777944885073,"version":"3.51.4"},"reference-count":41,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,7,19]],"date-time":"2025-07-19T00:00:00Z","timestamp":1752883200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,19]],"date-time":"2025-07-19T00:00:00Z","timestamp":1752883200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Womens Health (Lond Engl)"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>An alarming observation from high-volume obstetric facilities in Nepal indicating a decreased institutional delivery rate and increased institutional neonatal mortality rate after the initial nationwide lockdown signaled the adverse population-level impact of the pandemic on the national trajectory of neonatal survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>We aimed to estimate the impact of change in institutional delivery coverage on cause-specific neonatal mortality during the coronavirus disease 2019 pandemic in Nepal.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Modeling-based study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We used the open-access Lives Saved Tool, based on a linear deterministic mathematical model validated for estimating cause-specific neonatal mortality in low- and middle-income countries, to estimate the number of additional neonatal lives saved and neonatal mortality rates. Using coverage change in institutional delivery rates as a proxy for interventions during childbirth, we compared the estimates using \u2018reported\u2019 coverage change during the pandemic with the \u2018targets\u2019 per Nepal Every Newborn Action Plan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The projected number of additional neonatal lives saved when the pandemic hit the hardest (Nepalese fiscal year 2020\u20132021) when national annual institutional delivery rate reportedly decreased was lower (104; 95% confidence interval: 69\u2013148) compared to the target scenario (222; 95% confidence interval: 152\u2013313). However, in the next year 2021\u20132022 when the institutional delivery rate increased, the number was higher (926; 95% confidence interval: 643\u20131295) compared to target scenario (329; 95% confidence interval: 226\u2013466). The trajectory of the projected neonatal mortality rate per 1000 live births reversed (increased to 20.18) in 2020\u20132021 compared to 20.11 in 2019\u20132020 and then tracked down to 18.75 in 2021\u20132022. Most newborn lives would be saved from asphyxia, sepsis, and prematurity-related complications. Neonatal resuscitation, thermal protection, and cord care are the top three lifesaving interventions during childbirth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Neonatal survival in Nepal was adversely impacted during the peak of the coronavirus disease 2019 pandemic, with a favorable bounce back next year, based on the Lives Saved Tool projection per change in institutional delivery coverage.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17455057251347717","type":"journal-article","created":{"date-parts":[[2025,7,19]],"date-time":"2025-07-19T07:18:39Z","timestamp":1752909519000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of reduced institutional delivery coverage on neonatal survival during the peak of coronavirus disease 2019 pandemic in Nepal: Estimates using Lives Saved Tool model"],"prefix":"10.1177","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9158-8510","authenticated-orcid":false,"given":"Dinesh","family":"Dharel","sequence":"first","affiliation":[{"name":"Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada"},{"name":"Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepak","family":"Paudel","sequence":"additional","affiliation":[{"name":"Save the Children, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nazeem","family":"Muhajarine","sequence":"additional","affiliation":[{"name":"Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,7,19]]},"reference":[{"key":"e_1_3_2_2_2","unstructured":"National Statistics Office (NSO) Nepal. National Population and Housing Census 2021 (Internet). Government of Nepal 2023 https:\/\/nepal.unfpa.org\/en\/publications\/12th-national-population-and-housing-census-2021 (accessed 1 December 2024)."},{"key":"e_1_3_2_3_2","unstructured":"United Nations Development Programme. Human Development Report 2023\/2024: breaking the gridlock: reimagining cooperation in a polarized world (Internet). Stylus Publishing LLC 2024 https:\/\/hdr.undp.org\/content\/human-development-report-2023-24 (accessed 2 December 2024)."},{"key":"e_1_3_2_4_2","unstructured":"Dharel D Paudel D Muhajarine N. Estimating the indirect impact of the COVID-19 pandemic on neonatal mortality in Nepal (Internet). University of Saskatchewan 2023 https:\/\/hdl.handle.net\/10388\/14665 (accessed 2 December 2024)."},{"key":"e_1_3_2_5_2","unstructured":"London School of Hygiene and Tropical Medicine South Asian Institute for Policy Analysis and Leadership. Nepal: an exemplar in neonatal and maternal mortality reduction (Internet). Exemplars in Global Health https:\/\/www.exemplars.health\/topics\/neonatal-and-maternal-mortality\/nepal (accessed 2 December 2024)."},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(19)30163-9"},{"key":"e_1_3_2_7_2","unstructured":"Ministry of Health. Nepal\u2019s Every Newborn Action Plan (Internet). Government of Nepal 2016 https:\/\/www.healthynewbornnetwork.org\/hnn-content\/uploads\/NENAP-final-low-resolution.pdf (accessed 2 December 2024)."},{"key":"e_1_3_2_8_2","unstructured":"Ministry of Health and Population New ERA ICF. Nepal Demographic and Health Survey 2022 (Internet). 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