Correlates of continuum of maternal health services among Nepalese women: Evidence from Nepal Multiple Indicator Cluster Survey

Abstract

Continuum of Care (CoC) is an essential strategy to prevent maternal and child deaths where health services are arranged in a pathway throughout pregnancy, childbirth and after delivery. However, CoC is still a challenge in Nepal. This study aimed to investigate the correlates of CoC from pregnancy to the postnatal period in Nepalese women aged 15 to 49 years. Secondary analysis was performed on the data from Nepal Multiple Indicator Cluster Survey. This led to a sample size of 2086 women who had a live birth within two years preceding the survey. We constructed three outcome models and conducted multivariable logistic regression, to assess socio-economic and demographic correlates of CoC from pregnancy to childbirth to postnatal period. Overall, 41% of the women received Antenatal Care (ANC), delivery from Skilled Birth Attendant (SBA) as well as the Postnatal Care (PNC) during their most recent birth. Women from rural areas (aOR 0.25, 95%CI: 0.18, 0.36) had reduced odds of receiving CoC while women belonging to advantaged ethnic group (aOR 1.61, 95%CI: 1.18 2.19), from middle wealth status (aOR 2.56, 95%CI: 1.68, 3.91) and upper (aOR 4.50, 95%CI: 3.07, 6.59) wealth status, and women having access to media (aOR 1.76, 95%CI: 1.31, 2.37) had higher odds of receiving CoC from pregnancy to postnatal period. Having more than two births reduced the odds of CoC by 30% (aOR 0.70, 95%CI: 0.50, 0.98). These factors were also significantly associated with ANC services and the continuum from ANC to delivery SBA. The findings suggest that the majority of Nepalese women lack a continuity of care during their pregnancy and childbirth, and several socioeconomic factors affect the spectrum of CoC. Efforts to improve maternal health services utilization in a continuum require strategies that remove demand and supply barriers of health care utilization.

Determinants of the Continuum of Maternal Healthcare Services in Northwest Ethiopia: Findings from the Primary Health Care Project

“…However, this finding is lower than the result of studies done in Nepal, in which 41% of the women received ANC, SBA, and PNC during their most recent birth [ 30 ]. Additionally, our finding is much lower than those of studies conducted at Sohag governorate, Egypt, in which 50.4% of the women had achieved continuum of care measured (ANC+4 visit, delivered by a skilled birth attendant and had PNC) [ 31 ], and a study conducted in Cambodia, 60% of women had the full range of services for the continuum of maternal and newborn health care [ 32 ].…”

Influence of China’s 2009 healthcare reform on the utilisation of continuum of care for maternal health services: evidence from two cross-sectional household surveys in Shaanxi Province

“…However, this study found that the utilisation rates of CMHS have increased after China's 2009 healthcare reform but still remains low. Studies in other LMICs have shown that the rate of CMHS utilisation is low because of shortages in 5.0% of maternal women completed at least four antenatal visits, hospital delivery and at least once postnatal visits continuously in Ratanakiri, Cambodia [12]; 41% of maternal women completed at least one antenatal visit, hospital delivery and at least one postnatal visit continuously in Nepal [23]; 7.9% of women completed the continuum of care through continuous visits to health facilities in Ghana [43]. The post-reform survey data in this study showed only 20.56% of urban women and 19.26% of rural women made CMHS.…”

“…Recent studies have evaluated socio-economic inequalities and found socioeconomic determinants of prenatal and postnatal visits [17][18][19], explored influence of health policy on improving the utilisation of hospital delivery [20], prenatal or postnatal visits [21], fewer studies explore the utilisation of CMHS. To date, there has been some research exploring the determinants, effects, value and measurement of CMHS in LMICs outside of China: in Lao PDR [22], Nepal [23], Tanzania [10], South Africa [11], Cambodia [24]. This study aimed to fill the study gap on exploring the influence of health policy on improving the utilisation of CMHS in one province of China.…”

Influence of China’s 2009 healthcare reform on the utilisation of continuum of care for maternal health services: Evidence from two cross-sectional household surveys in Shaanxi Province

“…Therefore, we hypothesize that the utilisation of CHMS should have improved. To date, there has been some research exploring the determinants, effects, value, measurement of CHMS in Lao PDR [15], Nepal [16], Tanzania [17], South Africa [18], Cambodia [19]; fewer studies explore the influence of health policy on improving the utilisation of CMHS in China.…”

“…Studies in other LMICs have shown that the rate of CMHS utilisation is low because of shortages in human, financial resources and inadequate health-system infrastructure (although they used a different way to assess the continuum of care). There is 6.8% of maternal women received continuum of maternal, newborn and child health services in a rural district of Lao People's Democratic Republic [15]; 5.0% of maternal women received at least four times of antenatal visits, hospital delivery and at least once postnatal visits continuously in Ratanakiri, Cambodia[40]; 41% of maternal women received at least once antenatal visits, hospital delivery and at least once postnatal visits continuously in Nepal[16]; 7.9% of women achieved the continuum of care through continuous visits to health facilities in Ghana[41].…”