Investigation of technical quality of antenatal and perinatal services in a nationally representative sample of health facilities in Nepal

Khatri, Resham Bahadur; Durham, Jo; Assefa, Yibeltal

doi:10.1186/s13690-022-00917-z

Cited by 8 publications

(7 citation statements)

References 64 publications

(67 reference statements)

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“…Nepal Health Facility Survey (NHFS) revealed that only four out of 10 health facilities had carried out neonatal resuscitation and only 3% of Primary Health Care Centers (PHCCs) had performed all basic emergency obstetric signal functions at least once in the three months preceding the survey [19]. To improve the quality of perinatal care, a recent study indicated the need of implementing tailored strategies, including recruitment of health worker, supervision and onsite coaching and access to necessary equipment and medicine in health facilities [20].…”

Section: Introductionmentioning

confidence: 99%

Service readiness and availability of perinatal care in public hospitals - a multi-centric baseline study in Nepal

Chaulagain

Wrammert

Gurung

et al. 2022

BMC Pregnancy Childbirth

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Background Poor quality of maternal and newborn care contributes to nearly two million deaths of mothers and their newborns worldwide annually. Assessment of readiness and availability of perinatal care services in health facilities provides evidence to underlying bottlenecks for improving quality of care. This study aimed to evaluate the readiness and availability of perinatal care services in public hospitals of Nepal using WHO’s health system framework. Methods This was a mixed methods study conducted in 12 public hospitals in Nepal. A cross-sectional study design was used to assess the readiness and availability of perinatal care services. Three different data collection tools were developed. The tools were pretested in a tertiary maternity hospital and the discrepancies in the tools were corrected before administering in the study hospitals. The data were collected between July 2017 to July 2018. Results Only five out of 12 hospitals had the availability of all the basic newborn care services under assessment. Kangaroo mother care (KMC) service was lacking in most of the hospitals (7 out of 12). Only two hospitals had all health workers involved in perinatal care services trained in neonatal resuscitation. All of the hospitals were found not to have all the required equipment for newborn care services. Overall, only 60% of the health workers had received neonatal resuscitation training. A small proportion (3.2%) of the newborn infants with APGAR < 7 at one minute received bag and mask ventilation. Only 8.2% of the mothers initiated breastfeeding to newborn infants before transfer to the post-natal ward, 73.4% of the mothers received counseling on breastfeeding, and 40.8% of the mothers kept their newborns in skin-to-skin contact immediately after birth. Conclusion The assessment reflected the gaps in the availability of neonatal care services, neonatal resuscitation training, availability of equipment, infrastructure, information system, and governance. Rapid scale-up of neonatal resuscitation training and increased availability of equipment is needed for improving the quality of neonatal care services.

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Section: Introductionmentioning

confidence: 99%

Service readiness and availability of perinatal care in public hospitals - a multi-centric baseline study in Nepal

Chaulagain

Wrammert

Gurung

et al. 2022

BMC Pregnancy Childbirth

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“…For example, women from low-income households, rural areas, and ethnic minority groups are more likely to experience poor health outcomes and have limited access to healthcare services [ 23 ]. Recent studies also show that women utilize quality MNH services with better health facility capacity, especially the private ones since they provide better quality health services [ 29 , 30 ]. While the existing studies have noted a decrease in MCH service inequality between 2011 and 2016, the drivers of such decline are unknown.…”

Section: Introductionmentioning

confidence: 99%

Decomposing inequality in Maternal and Child Health (MCH) services in Nepal

G.C.

Adhikari

2023

BMC Public Health

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Background About 75.5% of women in Nepal’s urban areas receive at least four ANC visits, compared to 61.7% of women in the country’s rural areas. Similarly, just 34% of women in the lowest wealth quintile give birth in a medical facility compared to 90% of women in the richest group. As a result of this inequality, the poor in emerging nations suffer since those who are better off can make greater use of the healthcare than those who are less fortunate. This study aims to examine and decompose the contributions of various socioeconomic factors towards MCH service inequality in Nepal in the years 2011 and 2016. Methods Inequality in MCH services was estimated using concentration curves and their corresponding indices using data from Nepal Demographic Health Survey (NDHS) 2011 and 2016. We examined the inequality across three MCH service outcomes: less than 4 ANC visits, no postnatal checkups within 2 months of delivery and no SBA delivery and decomposed them across observed characteristics of the mothers aged between 15 and 49. Furthermore, Oaxaca-blinder decomposition approach was used to measure and decompose the inequality differential between two time periods. Results Inequality in MCH services was prevalent for all 3 MCH outcomes in 2011 and 2016, respectively. However, the concentration indices for <4 ANC visits, no SBA delivery, and no postnatal checkups within 2 months of birth increased from -0.2184, -0.1643, and -0.1284 to -0.1871, -0.0504, and -0.0218 correspondingly, showing the decrease in MCH services inequality over two time periods. Wealth index, women’s literacy, place of living, mother’s employment status, and problem of distance to reach nearest health facility were the main contributors. Conclusion We find that MCH services are clearly biased towards the women with higher living standards. National policies should focus on empowering women through education and employment, along with the creation of health facilities and improved educational institutions, in order to address inequalities in living standards, women’s education levels, and the problem of distance. Leveraging these factors can reduce inequality in MCH services.

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“…The facility readiness domain covers four sub-domains for both services: general readiness (e.g., water, electricity), equipment (e.g., delivery beds for childbirth services), medicine/commodities (e.g., misoprostol, magnesium sulphate, iron tablets), and staff and guidelines (e.g., availability of protocols, guidelines for training). Based on national guidelines for maternal and newborn care [36], and availability of information in the dataset [28], we contextualised and extracted information for the domain and subdomain-specific items for structural quality of health facility for MNH services taking reference of previous studies [13,28,34,36,37]. Based on the information available in dataset, a number of domain and sub-domain-specific items were identified to calculate the structural quality scores of health facilities for ANC, and perinatal services (Tables A and B in S1 File).…”

Section: Outcome Variables and Measurementmentioning

confidence: 99%

Assessment of health system readiness for routine maternal and newborn health services in Nepal: Analysis of a nationally representative health facility survey, 2015

Khatri

Assefa

Durham

2022

PLOS Glob Public Health

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Access to and utilisation of routine maternal and newborn health (MNH) services, such as antenatal care (ANC), and perinatal services, has increased over the last two decades in Nepal. The availability, delivery, and utilisation of quality health services during routine MNH visits can significantly impact the survival of mothers and newborns. Capacity of health facility is critical for the delivery of quality health services. However, little is known about health system readiness (structural quality) of health facilities for routine MNH services and associated determinants in Nepal. Data were derived from the Nepal Health Facility Survey (NHFS) 2015. Total of 901 health facilities were assessed for structural quality of ANC services, and 454 health facilities were assessed for perinatal services. Adapting the World Health Organization’s Service Availability and Readiness Assessment manual, we estimated structural quality scores of health facilities for MNH services based on the availability and readiness of related subdomain-specific items. Several health facility-level characteristics were considered as independent variables. Logistic regression analyses were conducted, and the odds ratio (OR) was reported with 95% confidence intervals (CIs). The significance level was set at p-value of <0.05. The mean score of the structural quality of health facilities for ANC, and perinatal services was 0.62, and 0.67, respectively. The average score for the availability of staff (e.g., training) and guidelines-related items in health facilities was the lowest (0.37) compared to other four subdomains. The odds of optimal structural quality of health facilities for ANC services were higher in private health facilities (adjusted odds ratio (aOR) = 2.65, 95% CI: 1.48, 4.74), and health facilities supervised by higher authority (aOR = 1.96; CI: 1.22, 3.13) while peripheral health facilities had lower odds (aOR = 0.13; CI: 0.09, 0.18) compared to their reference groups. Private facilities were more likely (aOR = 1.69; CI:1.25, 3.40) to have optimal structural quality for perinatal services. Health facilities of Karnali (aOR = 0.29; CI: 0.09, 0.99) and peripheral areas had less likelihood (aOR = 0.16; CI: 0.10, 0.27) to have optimal structural quality for perinatal services. Provincial and local governments should focus on improving the health system readiness in peripheral and public facilities to deliver quality MNH services. Provision of trained staff and guidelines, and supply of laboratory equipment in health facilities could potentially equip facilities for optimal quality health services delivery. In addition, supervision of health staff and facilities and onsite coaching at peripheral areas from higher-level authorities could improve the health management functions and technical capacity for delivering quality MNH services. Local governments can prioritise inputs, including providing a trained workforce, supplying equipment for laboratory services, and essential medicine to improve the quality of MNH services in their catchment.

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Investigation of technical quality of antenatal and perinatal services in a nationally representative sample of health facilities in Nepal

Cited by 8 publications

References 64 publications

Service readiness and availability of perinatal care in public hospitals - a multi-centric baseline study in Nepal

Service readiness and availability of perinatal care in public hospitals - a multi-centric baseline study in Nepal

Decomposing inequality in Maternal and Child Health (MCH) services in Nepal

Assessment of health system readiness for routine maternal and newborn health services in Nepal: Analysis of a nationally representative health facility survey, 2015

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