Factors affecting institutional delivery in rural Chitwan district of Nepal: a community-based cross-sectional study

Abstract Background Health facility delivery is considered a critical strategy to improve maternal health. The Government of Nepal is promoting institutional delivery through different incentive programmes and the establishment of birthing centres. This study aimed to identify the socio-demographic, socio-cultural, and health service-related factors influencing institutional delivery uptake in rural areas of Chitwan district, where high rates of institutional deliveries co-exist with a significant proportion of home deliveries. Methods This community-based cross-sectional study was conducted in six rural Village Development Committees of Chitwan district, which are characterised by relatively low institutional delivery rates and the availability of birthing centres. The study area represents both hilly and plain areas of Chitwan. A total of 673 mothers who had given birth during a one-year-period were interviewed using a structured questionnaire. Univariate and multivariable logistic regression analysis using stepwise backward elimination was performed to identify key factors affecting institutional delivery. Results Adjusting for all other factors in the final model, advantaged caste/ethnicity [aOR: 1.98; 95% CI: 1.15-3.42], support for institutional delivery by the husband [aOR: 19.85; 95% CI: 8.53-46.21], the decision on place of delivery taken jointly by women and family members [aOR: 5.43; 95% CI: 2.91-10.16] or by family members alone [aOR: 4.61; 95% CI: 2.56-8.28], birth preparations [aOR: 1.75; 95% CI: 1.04-2.92], complications during the most recent pregnancy/delivery [aOR: 2.88; 95% CI: 1.67-4.98], a perception that skilled health workers are always available [aOR: 2.70; 95% CI: 1.20-6.07] and a birthing facility located within one hour’s travelling distance [aOR: 2.15; 95% CI: 1.26-3.69] significantly increased the likelihood of institutional delivery. On the other hand, not knowing about the adequacy of physical facilities significantly decreased the likelihood of institutional delivery [aOR: 0.14; 95% CI: 0.05-0.41]. Conclusion With multiple incentives present, the decision to deliver in a health facility is affected by a complex interplay of socio-demographic, socio-cultural, and health service-related factors. Family decision-making roles and a husband’s support for institutional delivery exert a particularly strong influence on the place of delivery, and this should be emphasized in the health policy as well as development and implementation of maternal health programmes in Nepal.http://deepblue.lib.umich.edu/bitstream/2027.42/110661/1/12884_2015_Article_454.pd

Barriers and facilitators to institutional delivery in rural areas of Chitwan district, Nepal: A qualitative study

BACKGROUND Giving birth assisted by skilled care in a health facility plays a vital role in preventing maternal deaths. In Nepal, delivery services are free and a cash incentive is provided to women giving birth at a health facility. Nevertheless, about half of women still deliver at home. This study explores socio-cultural and health service-related barriers to and facilitators of institutional delivery. METHODS Six village development committees in hill and plain areas were selected in Chitwan district. We conducted a total of 10 focus group discussions and 12 in-depth-interviews with relevant stakeholder groups, including mothers, husbands, mothers-in-law, traditional birth attendants, female community health volunteers, health service providers and district health managers. Data were analyzed inductively using thematic analysis. RESULTS Three main themes played a role in deciding the place of delivery, i.e. socio-cultural norms and values; access to birthing facilities; and perceptions regarding the quality of health services. Factors encouraging an institutional delivery included complications during labour, supportive husbands and mothers-in-law, the availability of an ambulance, having birthing centres nearby, locally sufficient financial incentives and/or material incentives, the 24-h availability of midwives and friendly health service providers. Socio-cultural barriers to institutional deliveries were deeply held beliefs about childbirth being a normal life event, the wish to be cared for by family members, greater freedom of movement at home, a warm environment, the possibility to obtain appropriate ḧot\" foods, and shyness of young women and their position in the family hierarchy. Accessibility and quality of health services also presented barriers, including lack of road and transportation, insufficient financial incentives, poor infrastructure and equipment at birthing centres and the young age and perceived incompetence of midwives. CONCLUSION Despite much progress in recent years, this study revealed some important barriers to the utilization of health services. It suggests that a combination of upgrading birthing centres and strengthening the competencies of health personnel while embracing and addressing deeply rooted family values and traditions can improve existing programmes and further increase institutional delivery rates

Weather Based Strawberry Yield Forecasts at Field Scale Using Statistical and Machine Learning Models

Strawberry is a high value and labor-intensive specialty crop in California. The three major fruit production areas on the Central Coast complement each other in producing fruits almost throughout the year. Forecasting strawberry yield with some lead time can help growers plan for required and often limited human resources and aid in making strategic business decisions. The objectives of this paper were to investigate the correlation among various weather parameters related with strawberry yield at the field level and to evaluate yield forecasts using the predictive principal component regression (PPCR) and two machine-learning techniques: (a) a single layer neural network (NN) and (b) generic random forest (RF). The meteorological parameters were a combination of the sensor data measured in the strawberry field, meteorological data obtained from the nearest weather station, and calculated agroclimatic indices such as chill hours. The correlation analysis showed that all of the parameters were significantly correlated with strawberry yield and provided the potential to develop weekly yield forecast models. In general, the machine learning technique showed better skills in predicting strawberry yields when compared to the principal component regression. More specifically, the NN provided the most skills in forecasting strawberry yield. While observations of one growing season are capable of forecasting crop yield with reasonable skills, more efforts are needed to validate this approach in various fields in the region

Practising Politics as Medicine Writ Large in Nepal

Mahesh Maskey relates the story of how physicians have contributed to the volatile politics of Nepal in the last decades in the struggle to ensure health as a human right within the broader macroeconomic and political picture. He seeks to show, as one of the physicians engaged in movement, how physicians consciously have engaged in political work in Nepal, following Virchow's understanding of politics as medicine writ large (Eisenberg, 1987). Development (2004) 47, 122–130. doi:10.1057/palgrave.development.1100039