{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,22]],"date-time":"2025-02-22T00:39:23Z","timestamp":1740184763021,"version":"3.37.3"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2023,8,2]],"date-time":"2023-08-02T00:00:00Z","timestamp":1690934400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["JP21H03160"],"award-info":[{"award-number":["JP21H03160"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002241","name":"Japan Science and Technology Agency","doi-asserted-by":"publisher","award":["JPMJSP2108"],"award-info":[{"award-number":["JPMJSP2108"]}],"id":[{"id":"10.13039\/501100002241","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Maternal and newborn care quality can be measured in three dimensions (Dimensions 1: care provision, 2: care experience, and 3: human and physical resources); however, little is known about which dimensions are associated with newborn and perinatal deaths. We examined the association between care quality and newborn and perinatal deaths in Nepal. This study incorporated secondary data from Nepal Service Provision Assessments (NSPA) 2015 (623 delivery facilities, facility inventory survey; 1,509 women, ANC clients interviews; 1,544 women, ANC observation) and Nepal Demographic and Health Surveys (NDHS) 2016 (5,038 women who reported having given birth in the five years preceding data collection). The outcome variables were newborn and perinatal deaths derived from the NDHS. The exposure variables were district-level maternal and newborn care quality scores calculated from the NSPA data. Covariates were women\u2019s sociodemographic, health, and obstetric characteristics. We applied the administrative boundary method to link these two surveys. We conducted binary logistic regression analyses to examine the association between care quality and newborn\/perinatal deaths. In Dimension 1, higher mean and maximum quality scores at the district level were associated with a lower number of newborn deaths (mean: odds ratio [OR] = 0.04, 95% confidence interval [CI]: 0.00\u20130.76; max: OR = 0.09, 95% CI: 0.01\u20130.58), but not with perinatal deaths. In Dimensions 2 and 3, the quality score was not significantly associated with newborn deaths and perinatal. Enhancing the quality of care provision at its average and highest levels in each district may contribute to the reduction of newborn deaths, but not perinatal death. Health administrators should assess the quality of care at the administrative division level and focus on enhancing both average and maximum care quality of health facilities in each region in the care provision dimension.<\/jats:p>","DOI":"10.1371\/journal.pgph.0002101","type":"journal-article","created":{"date-parts":[[2023,8,2]],"date-time":"2023-08-02T17:29:38Z","timestamp":1690997378000},"page":"e0002101","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Improving the quality of maternal and newborn healthcare at the district level: Addressing newborn deaths in Nepal"],"prefix":"10.1371","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0408-8658","authenticated-orcid":true,"given":"Subaru","family":"Ikeda","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2058-1722","authenticated-orcid":true,"given":"Akira","family":"Shibanuma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5600-994X","authenticated-orcid":true,"given":"Alpha","family":"Pokharel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ram Chandra","family":"Silwal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5659-3237","authenticated-orcid":true,"given":"Masamine","family":"Jimba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,8,2]]},"reference":[{"issue":"11","key":"pgph.0002101.ref001","doi-asserted-by":"crossref","first-page":"e1196","DOI":"10.1016\/S2214-109X(18)30386-3","article-title":"High-quality health systems in the Sustainable Development Goals era: time for a revolution.","volume":"6","author":"ME Kruk","year":"2018","journal-title":"Lancet Glob Health"},{"issue":"6","key":"pgph.0002101.ref002","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.1093\/ije\/dyv115","article-title":"Institutional deliveries weakly associated with improved neonatal survival in developing countries: evidence from 192 Demographic and Health Surveys","volume":"44","author":"G Fink","year":"2015","journal-title":"Int J Epidemiol"},{"issue":"10160","key":"pgph.0002101.ref003","doi-asserted-by":"crossref","first-page":"2203","DOI":"10.1016\/S0140-6736(18)31668-4","article-title":"Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries","volume":"392","author":"ME Kruk","year":"2018","journal-title":"Lancet"},{"volume-title":"Standards for improving quality of maternal and newborn care in health facilities","year":"2016","author":"World Health Organization","key":"pgph.0002101.ref004"},{"volume-title":"WHO recommendations on antenatal care for a positive pregnancy experience","year":"2016","author":"World Health Organization","key":"pgph.0002101.ref005"},{"year":"2013","author":"World Health Organization","key":"pgph.0002101.ref006"},{"issue":"1","key":"pgph.0002101.ref007","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.ijgo.2009.04.008","article-title":"Perinatal audit using the 3-delays model in western Tanzania","volume":"106","author":"G Mbaruku","year":"2009","journal-title":"Int J Gynaecol Obstet"},{"issue":"11","key":"pgph.0002101.ref008","doi-asserted-by":"crossref","first-page":"e1176","DOI":"10.1016\/S2214-109X(18)30440-6","article-title":"Assessment of quality of primary care with facility surveys: a descriptive analysis in ten low-income and middle-income countries","volume":"6","author":"EK Macarayan","year":"2018","journal-title":"Lancet Glob Health"},{"issue":"4","key":"pgph.0002101.ref009","doi-asserted-by":"crossref","first-page":"e0214577","DOI":"10.1371\/journal.pone.0214577","article-title":"The quality of skilled birth attendants in Nepal: High aspirations and ground realities","volume":"14","author":"R Rajbhandari","year":"2019","journal-title":"PLoS One"},{"issue":"18","key":"pgph.0002101.ref010","doi-asserted-by":"crossref","first-page":"9612","DOI":"10.3390\/ijerph18189612","article-title":"Women\u2019s experience of disrespect and abuse during institutional delivery in Biratnagar, Nepal.","volume":"18","author":"NP Ghimire","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pgph.0002101.ref011","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s41043-018-0148-y","article-title":"Health system barriers influencing perinatal survival in mountain villages of Nepal: implications for future policies and practices","volume":"37","author":"M Paudel","year":"2018","journal-title":"J Health Popul Nutr"},{"volume-title":"States Agency for International Development U. 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