Abstract
BackgroundNepal has improved access and utilisation of routine maternal and newborn health (MNH) services. Despite improved access to routine MNH services such as antenatal care (ANC), and delivery and postnatal care (PNC) services, the burden of maternal and neonatal deaths in Nepal remains high. Most of those deaths could be prevented by improving utilisation of evidence-informed clinical MNH interventions. However, little is known on determinants of utilisation of such clinical MNH interventions in health facilities (HFs). This study investigated the determinants of utilisation of technical quality MNH services in Nepal.MethodsThis study used data from the 2015 Nepal Services Provision Assessment. A total of 523 pregnant and 309 postpartum women were included for the analysis of utilisation of technical quality of ANC, and delivery and PNC services, respectively. Outcome variables were utilisation of better quality i) ANC services, and ii) delivery and PNC services while independent variables included features of HFs and health workers, and demographic characteristics of pregnant and postpartum women. Binomial logistic regression was conducted to identify the determinants associated with utilisation of quality MNH services. The odds ratio with 95% confidence interval (CIs) were reported at the significance level of p < 0.05 (two-tailed).ResultsWomen utilised quality ANC services if they attended facilities with better HF capacity (aOR = 2.12;95% CI: 1.03, 4.35). Women utilised better quality delivery and PNC services from private HFs compared to public HFs (aOR = 2.63; 95% CI: 1.14, 6.08). Women utilised better technical quality ANC provided by nursing staff compared to physicians (adjusted odds ratio (aOR) =2.89; 95% CI: 1.33, 6.29), and from staff supervised by a higher authority compared to those not supervised (aOR = 1.71; 95% CI: 1.01, 2.92). However, compared to province one, women utilised poor quality delivery and PNC services from HFs in province two (aOR = 0.15; 95% CI: 0.03, 0.63).ConclusionsWomen utilised quality MNH services at facilities with better HF capacity, service provided by nursing staff, and attended at supervised HFs/health workers. Provincial and municipal governments require strengthening HF capacities (e.g., supply equipment, medicines, supplies), recruiting trained nurse-midwives, and supervising health workers.
Highlights
Over the past two decades, Nepal has made significant improvements in accessing routine maternal and newborn health (MNH) services such as antenatal care (ANC), delivery and postnatal care (PNC) services [1]
Evidence indicates improvement is associated with the implementation of the Safe Delivery Incentive Program (SDIP) in 2006 in Nepal [2], a nationwide program providing conditional cash transfers to women who deliver at a health facility (HF) assisted by skilled birth attendants (SBAs) and who attend at least four ANC visits and delivery, mostly in public HFs and some private HFs [2, 3]
Descriptive characteristics of women Table 1 shows the descriptive characteristics of women who attended HFs for the first ANC visit, and women who delivered at HFs and discharged on the day of the facility survey
Summary
Over the past two decades, Nepal has made significant improvements in accessing routine maternal and newborn health (MNH) services such as antenatal care (ANC), delivery and postnatal care (PNC) services [1]. A study in India showed that improved access to MNH services has not significantly reduced maternal and neonatal deaths [4] One explanation for this is that the quality of care that women receive across the MNH continuum of care (CoC) is poor and is having a limited effect on mortality. Despite improved access to routine MNH services such as antenatal care (ANC), and delivery and postnatal care (PNC) services, the burden of maternal and neonatal deaths in Nepal remains high. Most of those deaths could be prevented by improving utilisation of evidence-informed clinical MNH interventions. This study investigated the determinants of utilisation of technical quality MNH services in Nepal
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