BACKGROUND Increased coverage of antenatal care and facility births might not improve maternal and newborn health outcomes if quality of care is sub-optimal. Our study aimed to assess the facility readiness and health worker knowledge required to provide quality maternal and newborn care. METHODS Using an audit tool and interviews, respectively, facility readiness and health providers' knowledge of maternal and immediate newborn care were assessed at all 23 birthing centers (BCs) and the District hospital in the rural southern Nepal district of Sarlahi. Facility readiness to perform specific functions was assessed through descriptive analysis and comparisons by facility type (health post (HP), primary health care center (PHCC), private and District hospital). Knowledge was compared by facility type and by additional skilled birth attendant (SBA) training. RESULTS Infection prevention items were lacking in more than one quarter of facilities, and widespread shortages of iron/folic acid tablets, injectable ampicillin/gentamicin, and magnesium sulfate were a major barrier to facility readiness. While parenteral oxytocin was commonly provided, only the District hospital was prepared to perform all seven basic emergency obstetric and newborn care signal functions. The required number of medical doctors, nurses and midwives were present in only 1 of 5 PHCCs. Private sector SBAs had significantly lower knowledge of active management of third stage of labor and correct diagnosis of severe pre-eclampsia. While half of the health workers had received the mandated additional two-month SBA training, comparison with the non-trained group showed no significant difference in knowledge indicators. CONCLUSIONS Facility readiness to provide quality maternal and newborn care is low in this rural area of Nepal. Addressing the gaps by facility type through regular monitoring, improving staffing and supply chains, supervision and refresher trainings is important to improve quality.

中文翻译：

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评估设施和卫生工作者是否准备在尼泊尔南部农村提供优质的产前，产中和产后护理。

背景技术如果护理质量欠佳，那么增加产前护理和分娩的覆盖范围可能不会改善母婴健康结局。我们的研究旨在评估提供优质孕产妇和新生儿护理所需的设施准备情况和卫生工作者的知识。方法分别使用审计工具和访谈，对尼泊尔南部农村地区的萨拉利（Sarlahi）的所有23个分娩中心（BCs）和地区医院的设施准备情况和卫生服务提供者的孕产妇和即时新生儿保健知识进行了评估。通过描述性分析和按设施类型（卫生站（HP），初级保健中心（PHCC），私立医院和地区医院）进行比较，评估了设施执行特定功能的准备情况。通过设施类型和其他熟练的接生员（SBA）培训对知识进行了比较。结果超过四分之一的设施缺少预防感染的物品，铁/叶酸片，可注射的氨苄青霉素/庆大霉素和硫酸镁的普遍短缺是设施准备就绪的主要障碍。虽然通常提供肠胃外催产素，但只有地区医院准备执行所有七个基本的紧急产科和新生儿护理信号功能。在5个初级保健中心中，只有1个有所需的医生，护士和助产士人数。私营部门的SBA对第三产程的积极管理和严重子痫前期的正确诊断的知识明显较低。虽然一半的卫生工作者已经接受了规定的为期两个月的SBA培训，与未经训练的组比较，知识指标没有显着差异。结论在尼泊尔这个农村地区，提供优质孕产妇和新生儿护理的设施准备水平很低。通过定期监控，改善人员配备和供应链，监督和进修培训来弥补设施类型的差距，对于提高质量至关重要。