Factors affecting health facility delivery in rural Nawalparasi district of Nepal

Objective: In Nepal, both percentage of women giving birth at health facility and proportion of birth assisted by skilled birth attendant is very low. The purpose of this research was to investigate the factors related to health facility delivery in two levels of care in Nepal: primary health care and tertiary health care facilities. Methods: A cross-sectional household survey was conducted in seven villages of a district lying in plain area of Nepal: Nawalparasi. A structured interview questionnaire was developed and administered face-to-face. Descriptive analysis along with chi-square test and multinomial logistic regression was used to identify the predictors of institutional delivery. Results: Women were significantly more likely to deliver at health care facilities compared to home if the distance was less than one hour, belonged to advantaged caste, had radio, television and motorbike/scooter, decision maker for place of delivery was husband, reported their frequency of antenatal (ANC) visits at 4 or more and belonged to age group 15-19. Conclusion: Women have less control over making decisions related to their choice for place of birth rather it is mostly made by husbands. The findings highlight importance of having four or more ANC visits to the health institutions and that it should be located within one-hour walking distance. Inequity in utilisation of delivery services at health institutions exists as showed by low utilisation of such services by disadvantaged caste

Evaluation a Community Maternal Health Programme: Lessons Learnt

Abstract Using the example of a community-based health promotion intervention, this paper explores the important triangle between health promotion theory, intervention design, and evaluation research. This paper first outlines the intervention and then the mixed-method evaluation. In 2007, a non-governmental organisation (NGO) designed and implemented an intervention to improve the uptake of maternal health provision in rural Nepal. A community-based needs assessment preceded this novel health-promotion intervention that empowered women with information on the benefits of seeking care. The intervention had a flexible design and, at several points, the intervention’s progress was assessed and, where necessary, changes were made. The intervention targeted women of childbearing age and people (e.g. mothers-in-law and husbands) who influence these women’s ability to access health services. The intervention attempted to incorporate the diverse and changing needs of the local communities to make it more culturally appropriate (e.g. around traditions and beliefs linked to caste/ethnicity and socio-economic status) and to make the best of the existing resources whether these belong to the government or other NGOs. The research aimed to assess whether the planned health promotion activities improved maternal health service uptake. Greater access to maternal care should result in fewer women suffering from complications during childbirth, especially when complications are detected earlier and dealt with by skilled birth attendants. One key assumption was that health promotion would help improve knowledge, attitudes, and beliefs towards seeking care, especially during pregnancy complications. The programme ran for six years with the final evaluation in 2012

Factors affecting the uptake of institutional delivery, antenatal and postnatal care in Nawalparasi district, Nepal

© 2019, Kathmandu University. All rights reserved. Background Maternal deaths and complications are highly preventable with good antenatal, postnatal and skilled care during childbirth. Inadequate information on the factors affecting these services could be barrier to a reduction of maternal deaths in low-income countries. Objective To assess the uptake of antenatal, postnatal and skilled care during childbirth. Method A cross-sectional study was conducted in eight villages of Nawalparasi district in southern Nepal. A total of 447 women who had given birth within the preceding 24 months were recruited using multistage random sampling. Data were collected using a pre-tested semi-structured questionnaire. Chi-square tests were used to assess association between variables. Result Over 70% of women had gone for at least four antenatal care check-ups while only 14.3% had at least three postnatal check-ups in their last pregnancies. The proportion of institution delivery was 54%. Women’s literacy was associated with the uptake of antenatal services (p=<0.001), postnatal care (p=0.04) and institutional delivery (p=<0.001). Knowledge of antenatal (p=<0.001) and postnatal care was also associated with uptake of respective services (p=<0.001). Conclusion The uptake and knowledge of antenatal care was much better than of postnatal care. Home delivery rates were still very high. A scaling-up of education and awareness-raising interventions in this community could help improve the uptake of maternal health services

Assessing knowledge and behavioural changes on maternal and newborn health among mothers following post-earthquake health promotion in Nepal

Disasters can disrupt the existing health system affecting the whole population, but especially vulnerable people such as pregnant women, new mothers and their babies. Despite the global progress in maternal, newborn and child health (MNCH) programmes over the years, emergency responses after a disaster are often poor. Post-disaster health promotion could play an important role in improving MNCH outcomes. However, evidence remains limited on the effect of post disaster health promotion activities in low-income countries such as Nepal. Methods This is an uncontrolled before and after study conducted in Dhading district which was severely affected by the 2015 earthquake in Nepal. The study participants were mothers who had a child in the previous 12 months. The intervention was implemented between 2016 and 2018 and included community-engagement health promotion activities where the local stakeholders and resources were mobilized. The outcome variables included: knowledge of danger signs of pregnancy, childbirth and in newborns; and behaviours including ever attending antenatal care (ANC), a minimum of four ANC sessions and having an institutional delivery. Data were analysed using chi-squared tests, independent sample t-tests and multiple logistic regression models. Results In total 364 mothers were recruited in the pre-intervention group and 377 in the post-intervention group. The post-intervention group was more likely to have knowledge of at least three danger signs in pregnancy (AOR [Adjusted Odds Ratio] = 2.96, P<0.001), at least three danger signs in childbirth (AOR = 3.8, P<0.001), and at least five danger signs in newborns (AOR = 1.56, P<0.001) compared to the pre-intervention group. The mothers in the post-intervention group were also more likely to ever attend ANC (AOR = 7.18, P<0.001), attend a minimum of four ANC sessions (AOR = 5.09, P<0.001), and have institutional deliveries (AOR = 2.56, P<0.001). Religious minority groups were less likely to have knowledge of all danger signs compared to the majority Hindu group. Mothers from poorer households were also less likely to attend four ANC sessions. Mothers with higher education were more likely to have knowledge of all the danger signs. Mothers whose husbands had achieved higher education were also more likely to have knowledge of danger signs and have institutional deliveries. Conclusion Health promotion intervention helped the disaster-affected mothers in improving the knowledge and behaviours related to MNCH. However, the vulnerable population would need more support to gain benefit from such intervention

Mental health issues in pregnant women in Nepal

Mental health of pregnant women and new mothers is a growing area of concern in both low- and high-income countries. This editorial highlights some of the key mental issues faced by women in rural Nepal and outlines an intervention based on training community health care workers by experienced UK volunteers

Mental health training for community maternity workers in Nepal

Background: Mental health is a difficult topic to discuss in Nepal. This makes it hard for front-line maternity-care providers to start a discussion about mental health issues with women. As Nepal has not yet recognised midwifery as a profession, this UK-funded programme (THET) aims to train community health workers i.e. Auxiliary Nurse Midwives (ANMs) on mental health issues related to pregnancy. Purpose/Objective: This needs assessment, of all ANMs working in one district, assesses knowledge of perinatal mental health issues and future training needs. Method: This quantitative study used a structure questionnaire in Nepali at the start of the training of ANMs. The questions covered knowledge, views on mental health and illness and previous training on the topic. Ethical approval was granted by the Nepal Health Research Council (NHRC). Key Findings: In total 74 questionnaires were returned (out of 76). With 97% of ANMSs reporting they never had specific training issues around perinatal mental health. Their knowledge on perinatal mental health is poor, half of them are not aware that pregnancy and childbirth can cause mental illness. People do not talk openly about mental health problem in their local community. Most ANM thought specialised training on perinatal mental health would be useful. Discussion: Mental health in pregnancy/childbirth is often ignored especially in low-income countries like Nepal. In a country without recognised midwives there is a great need to improve attitudes and skills among community-based maternity workers who lacking training on maternity-related mental health issues. There is a great need for a national curriculum to facilitate relevant training

Factors affecting health facility delivery in rural Nawalparasi, Nepal

Safe delivery means giving birth in presence of skilled birth attendants (SBA) at health facilities where basic obstetric care is available preferably with midwives as main providers and emergency obstetric care for complications in hospitals with skilled doctors as main providers. In Nepal, both percentage of women giving birth at health facilities and the proportion of birth attended by skilled birth attendants is very low. This research investigates factors related to health facility delivery in two levels of care : primary health care and tertiary health care facilities