Abstract
In many low income developing countries, socioeconomic, environmental and demographic factors have been linked to around half of the disease related deaths that occur each year. The aim of this study is to investigate the sociodemographic factors, mother and child health status, water, sanitation, and hygienic conditions of a Nepalese community residing in a hilly rural village, and to identify factors associated with mother and child health status and the occurrence of diarrheal and febrile disease. A community-based cross-sectional survey was carried out and 315 households from the village of Narjamandap were included in this study. Factors associated with diarrhea, febrile disease, and full maternal and under-five immunizations were assessed using logistic regression. Results showed that higher education level (middle school versus primary education; Odds Ratio (OR): 0.55, p = 0.04; high school versus primary education; OR 0.21, p = 0.001) and having a toilet facility at home were significantly associated with a lower risk of developing diarrhea and febrile disease (OR 0.49, p = 0.01), while, interestingly, the use of improved water supply was associated with higher risk (OR 3.07, p = 0.005). In terms of maternal immunization, the odds of receiving a tetanus toxoid vaccination were higher in women who had regular antenatal checkups (OR 12.9, p < 0.001), and in those who developed complications during pregnancy (OR 4.54, p = 0.04); for under-five immunization, the odds of receiving full vaccination were higher among children from households that reported diarrhea (OR 2.76, p < 0.001). The findings of this study indicated that gaps still exist in the mother and child healthcare being provided, in terms of receiving antenatal checkups and basic immunizations, as evidenced by irregular antenatal checkups, incomplete and zero vaccination cases, and higher under-five deaths. Specific public health interventions to promote maternal health and the health of under-five children are suggested.
Highlights
Around 52% of deaths in low-income countries in 2015 occurred because of pregnancy-related complications, childbirth, postpartum care, water and vector borne diseases, nutritional, and vaccine preventable diseases [1].There are many factors linked to morbidity and mortality, such as socio-economic and demographic characteristics of the families, education status, geographical location, age of the mother, water, sanitation and hygiene facilities, and the health care delivery system [2,3]
The prevalence, within a four-week period, of acute diarrhea and fever among the study population during the survey (December–January) was reported to be 21.6% and 35.2% respectively, which was high compared to the findings of the Nepal Demographic and Health Survey (NDHS) [3]
Our results showed that the odds of being fully vaccinated with the Tetanus toxoid (TT) vaccine were significantly higher in mothers who had regular antenatal care, developed any complications during pregnancy and delivered in the hospital; the odds of receiving full vaccination for under-five children were significantly higher in children who had diarrhea—in other words, contact with health providers at any point during pregnancy, or the appearance of disease symptoms, significantly increased the chances of being vaccinated
Summary
There are many factors linked to morbidity and mortality, such as socio-economic and demographic characteristics of the families, education status, geographical location, age of the mother, water, sanitation and hygiene facilities, and the health care delivery system [2,3]. Nepal is a small, landlocked, developing country located between India and China. Its geographical location (being landlocked), difficult topography, and political instability are the main factors hindering health care reforms in the country [4]. As of 2016, around 80% of the total population lives in rural areas [5], where health care services are limited. Many of the mountainous areas are sparsely populated provision of basic health care services, such as antenatal care, immunization, and institutionalized delivery, becomes more challenging. The number of health care workers available in the country is 7/10,000, below the standard 23/10,000 recommended by the World
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