Abstract
BackgroundDisparities in the use of maternal, neonatal and child health (MNCH) services remain a concern in Low- and Middle-Income countries such as Nepal. Commonly observed disparities exist in education, income, ethnic groups, administrative regions and province-level in Nepal. In order to improve equitable outcomes for MNCH and to scale-up quality services, an Investment Case (IC) approach was lunched in the Asia Pacific region. The study assessed the impact of the IC intervention package in maternal and child health outcomes in Nepal.MethodsThe study used a quasi-experimental design extracting data from the Nepal Demographic Health Surveys – 2011 (pre-assessment) and 2016 (post-assessment) for 16 intervention and 24 control districts. A Difference in Difference (DiD) analysis was conducted to assess the impact of the intervention on maternal and child health outcomes. The linear regression method was used to calculate the DiD, adjusting for potential covariates. The final models were arrived by stepwise backward method including the confounding variables significant at p < 0.05.ResultsThe results of the DiD analyses showed at least four antenatal care visits (ANC) decreased in the intervention area (DiD% = − 4.8), while the delivery conducted by skilled birth attendants increased (DiD% = 6.6) compared to control area. However, the adjusted regression coefficient showed that these differences were not significant, indicating a null effect of the intervention. Regarding the child health outcomes, children with underweight (DiD% = 6.3), and wasting (DiD% = 5.4) increased, and stunting (DiD% = − 6.3) decreased in the intervention area compared to control area. The adjusted regression coefficient showed that the difference was significant only for wasting (β = 0.019, p = 0.002), indicating the prevalence of wasting increased in the intervention group compared to the control group.ConclusionThe IC approach implemented in Nepal did not show improvements in maternal and child health outcomes compared to control districts. The use of the IC approach to improve MCH in Nepal should be discussed and, if further used, the process of implementation should be strictly monitored and evaluated.
Highlights
Disparities in the use of maternal, neonatal and child health (MNCH) services remain a concern in Low- and Middle-Income countries such as Nepal
Changes in the outcome variables over time Maternal and child health (MCH) outcome variables pre- and post-assessment by intervention and control districts are shown in Table 3, as well as the results of the Difference in Difference (DiD) analysis estimating the impact of the intervention
The Investment Case (IC) intervention was implemented based on Tanahashi model (1978) to support equitable outcomes for maternal, neonatal and child health and to scale-up quality services aiming to identify the gaps in the quality and effectiveness in service delivery
Summary
Disparities in the use of maternal, neonatal and child health (MNCH) services remain a concern in Low- and Middle-Income countries such as Nepal. Despite the several efforts to improve the health status of mothers and children, maternal and child mortality remains a major global concern According to the Nepal Multi Indicator Cluster Survey 2019, 77.8% of pregnant women accomplished at least four antenatal care visits (ANC), 79.3% of births were accompanied by a Skilled Birth Attendant (SBA); more than half of the newborns were exclusively breastfed (62.1%), symptoms of malnourishment were found in one third of the children: stunting (31.5%), wasting (12%) and underweight is 24.3 % [7]
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