Background: One out of two neonatal deaths and 2 out of 5 maternal deaths occur at home in Nepal. An essential intervention in reducing maternal mortality and neonatal death is institutional delivery. The objective of this study was to find out the external environmental, predisposing, and enabling factors associated with the use of institutional delivery care in Nepal. Methods: Data from Nepal Demographic and Health Surveys (NDHS) 2016 was used to estimate socio-economic, provincial, and use of media differentials with institutional delivery under the Andersen behavioral model framework using multilevel regression analysis. Results: More than half of the women (60.9%) among 3899 women with last birth had their babies delivered in a health facility. In the multilevel logistic regression analysis, we found that women from province 2 (OR = 0.47 95%CI: 0.28-0.79) were significantly less likely to deliver in health institutions, and province 7 (OR = 1.76, 95%CI: 1.05-2.94) were significantly more likely deliver in a health institution. Age (OR = 0.94, 95%CI: 0.92-0.95) was also significantly associated with the place of delivery. Women with higher education (OR = 3.17, 95%CI: 2.09-4.81) were most likely to go for institutional delivery. The odds of women opting for institutional delivery were 3 folds more for those who had visited Antenatal Care (ANC) 4 or more times compared to those who did not. Conclusion: The results highlight the need for governments and health care providers to emphasize the promotion of institutional delivery and ANC visits as per protocol with a special focus on underprivileged communities. The use of multi-media is a vital strategy to promote the use of institutional delivery services.

Background: With the formulation of the National Safe Motherhood Policy in 1998, safe motherhood has forever been a priority program in Nepal. Under the safe motherhood program, every woman is provided with essential maternal health care services until now through the four-tire district health care system. There is a considerable increase in the utilization of antenatal care (ANC) by a skilled health provider from 2011 to 2016, 58 to 84%, respectively. However, inequality, exclusion, and under-utilization in health care services continue in many regions of Nepal. The present study aimed to explore the different types of socio-demographic factors associated with current ANC service utilization in Nepal. Methods: A cross-sectional study was conducted using the Nepal Demographic and Health Surveys data (DHS-7, 2016-2017). We estimated the latest pregnancy and live births in recent 5 years with the utilization of ANC services, and socioeconomic differentials in these indicators under the framework of the Andersen behavioral model. Results: Two in three (69.8%) with last birth accessed at least four ANC visits. The rate of live birth was about 98.6% in the ANC4+ group, higher than that of 96.8% in the ANC4-group (χ2: 14.742, P < 0.001). In the multilevel logistic regression analysis, we found that women from province 2 (OR: 0.48; 95%CI: 0.32-0.74) and province 6 (OR: 0.46; 95%CI: 0.30-0.71) were significantly less likely to visit ANC 4 or more times. Age (OR: 0.95; 95%CI: 0.93-0.96) was also significantly associated with the frequency of ANC visits. Level of Women's education and education of her partner were both significantly associated with the ANC visits: women (OR: 4.64; 95%CI: 3.05-7.05) and her partner (OR: 1.45; 95%CI: 1.01-2.06) having higher education were most likely to go for the recommended number of ANC visits. Moreover, women having exposure to multimedia were more likely to go for four or more ANC checkups. Conclusions: The results highlight the need for governments and health care providers to develop special health promotion program with a focus on the vulnerable and disadvantaged and to use multi-media for maternal health literacy improvement flexibly, and maternal health system strengthening.

Background: The Preschool Anxiety Scale (PAS)-Parent version scale is a 28-item measure designed to assess anxiety symptoms in preschoolers aged 3−6 years. The aim of this study was to assess the psychometric properties of the Nepali translated version of the PAS-Parent version.Methods: A descriptive cross-sectional design was used to collect data from 680 mothers among seven conveniently selected schools in Kathmandu. Results:The difference in PAS-Parent version scores across age groups was found to be statistically significant. In confirmatory factor analysis, 28 items showed a poor fit of the five-factor original model for the data. However, removing three items (25 item version) through the five-factor model indicated a better fit. Internal consistency measured by Cronbach's α for the PAS-Parent version scale was of good range (0.87). Cronbach's α of the subscales: generalized anxiety (0.63), social phobia (0.67), physical injury fears (0.75), and separation anxiety (0.63) were in fair range; while it was in poor range for the obsessive-compulsive subscale (0.567). Conclusion:Nepali version of the PAS demonstrated fair psychometric properties, supporting its utility in screening and assessing a broad range of anxiety symptoms in Nepalese preschoolers.