Abstract
BackgroundGlobally in 2017 neonatal death accounted for 46% of under-five deaths. Nepal is among the developing countries which has a high number of neonatal deaths. The rates are high among poor socio-economic groups, marginalized, as well as people living in remote areas of Nepal. This paper, thus tries to examine the utilization pattern and maternal, household, and health service factors affecting underprivileged ethnic groups in Midwest Nepal.MethodsA cross-sectional mixed method study was conducted from September 2017 to April 2018 in Bardiya district. Quantitative data were collected from a household survey of women who gave live births within the last 12 months prior to data collection (n = 362). Interviews were also undertaken with 10 purposively selected key informants. Logistic regression model was used to determine the factors associated with essential neonatal care utilization. Thematic analysis was undertaken on the qualitative data.ResultsOverall, neonatal care utilization was 58.6% (53.3–63.7%), with big variations seen in the coverage of selected neonatal care components. Factors such as birth order (2.059, 1.13–3.75), ethnicity (2.28, 1.33–3.91), religion (2.37, 1.03–5.46), perceived quality of maternal and neonatal services (2.66, 1.61–4.39) and awareness on immediate essential newborn cares (2.22, 1.28–3.87) were identified as the determining factors of neonatal care utilization.ConclusionsThe coverage of birth preparedness and complication readiness, adequate breastfeeding, and postnatal care attendance were very low as compared to the national target for each component. The determinants of essential neonatal care existed at maternal, household as well as health facility level and included ethnicity, religion, perceived quality of maternal and neonatal services, birth order and awareness on immediate essential newborn care. Appropriate birth spacing, improving the quality of maternal and neonatal services at health facilities and raising mother’s level of awareness about neonatal care practices are recommended.
Highlights
In 2017 neonatal death accounted for 46% of under-five deaths
It is among the districts with high neonatal mortality, with a high occurrence of newborn danger signs including bacterial infections and low utilization of essential neonatal care services compared with the national status
65% of the mothers had the perception that health facilities in their catchment area are offering good quality health services
Summary
In 2017 neonatal death accounted for 46% of under-five deaths. Nepal is among the developing countries which has a high number of neonatal deaths. 3 million neonates die every year due to lack of appropriate care at a global level [2] of which the highest burden (98%) occurs in the middle and low-income countries [3]. The key direct causes of neonatal death are preterm births (28%), neonatal infections (26%), birth asphyxia (23%) and neonatal tetanus (7%) [4]. Most of such deaths can be averted through low-cost interventions; for instance, antenatal care, appropriate care at birth and essential neonatal cares [5]. The vast majority of newborns and mothers in middle and low-income countries like Nepal do not get optimal care in this period
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