Equity in utilisation of maternal healthcare services: a mixed methods investigation of antenatal, delivery, and postnatal care among squatter and non-squatter residents living in Ward 34, Kathmandu, Nepal

This thesis describes a three-phase mixed-method investigation into the utilisation of antenatal, delivery, and postnatal care among women living in squatter and non-squatter settlements of Ward 34, Kathmandu, Nepal. The study sought to increase knowledge about the utilisation of maternal healthcare services and to better understand how and why inequalities in utilisation may arise. The results highlight the need to address the provision of maternal healthcare for the poorest women in Kathmandu

Contribution of Nepal’s Free Delivery Care Policies in Improving Utilisation of Maternal Health Services

Abstract Background: Nepal has made remarkable improvements in maternal health outcomes. The implementation of demand and supply side strategies have often been attributed with the observed increase in utilization of maternal healthcare services. In 2005, Free Delivery Care (FDC) policy was implemented under the name of Maternity Incentive Scheme (MIS), with the intention of reducing transport costs associated with giving birth in a health facility. In 2009, MIS was expanded to include free delivery services. The new expanded programme was named “Aama” programme, and further provided a cash incentive for attending four or more antenatal visits. This article analysed the influence of FDC policies, individual and community level factors in the utilisation of four antenatal care (4 ANC) visits and institutional deliveries in Nepal. Methods: Demographic and health survey data from 1996, 2001, 2006 and 2011 were used and a multi-level analysis was employed to determine the effect of FDC policy intervention, individual and community level factors in utilisation of 4 ANC visits and institutional delivery services. Results: Multivariate analysis suggests that FDC policy had the largest effect in the utilisation of 4 ANC visits and institutional delivery compared to individual and community factors. After the implementation of MIS in 2005, women were three times (adjusted odds ratio [AOR]=3.020, P<.001) more likely to attend 4 ANC visits than when there was no FDC policy. After the implementation of Aama programme in 2009, the likelihood of attending 4 ANC visits increased six-folds (AOR=6.006, P<.001) compared prior to the implementation of FDC policy. Similarly, institutional deliveries increased two times after the implementation of the MIS (AOR=2.117, P<.001) than when there was no FDC policy. The institutional deliveries increased five-folds (AOR=5.116, P<.001) after the implementation of Aama compared to no FDC policy. Conclusion: Results from this study suggest that MIS and Aama policies have had a strong positive influence on the utilisation of 4 ANC visits and institutional deliveries in Nepal. Nevertheless, results also show that FDC policies may not be sufficient in raising demand for maternal health services without adequately considering the individual and community level factor

Children's environmental health: an under-recognised area in paediatric health care

The knowledge that the environment in which we live, grow and play, can have negative or positive impacts on our health and development is not new. However the recognition that adverse environments can significantly and specifically affect the growth and development of a child from early intrauterine life through to adolescence, as well as impact their health later in adulthood, is relatively recent and has not fully reached health care providers involved in paediatric care

Poor Thermal Care Practices among Home Births in Nepal: Further Analysis of Nepal Demographic and Health Survey 2011

Introduction - Hypothermia is a major factor associated with neonatal mortality in low and middle income countries. Thermal care protection of newborn through a series of measures taken at birth and during the initial days of life is recommended to reduce the hypothermia and associated neonatal mortality. This study aimed to identify the prevalence of and the factors associated with receiving ‘optimum thermal care’ among home born newborns of Nepal. Methods - Data from the Nepal Demographic and Health Surveys (NDHS) 2011 were used for this study. Women who reported a home birth for their most recent childbirth was included in the study. Factors associated with optimum thermal care were examined using Chi-square test followed by logistic regression. Results - A total of 2464 newborns were included in the study. A total of 57.6 % were dried before the placenta was delivered; 60.3% were wrapped; 24.5% had not bathing during the first 24 hours, and 63.9% were breastfed within one hour of birth. Overall, only 248 (10.7%; 95% CI (8.8 %, 12.9%)) newborns received optimum thermal care. Newborns whose mothers had achieved higher education (OR 2.810; 95% CI (1.132, 6.976)), attended four or more antenatal care visits (OR 2.563; 95% CI (1.309, 5.017)), and those whose birth were attended by skilled attendants (OR 2.178; 95% CI (1.428, 3.323)) were likely to receive optimum thermal care. Conclusion - The current study showed that only one in ten newborns in Nepal received optimum thermal care. Future newborn survival programs should focus on those mothers who are uneducated; who do not attend the recommended four or more attend antenatal care visits; and those who deliver without the assistance of skilled birth attendants to reduce the risk of neonatal hypothermia in Nepal

Factors associated with the utilisation of postnatal care services among the mothers of Nepal: analysis of Nepal Demographic and Health Survey 2011

Background: Postnatal care is essential to save the life of the mother and newborn. Knowledge on the determinants of postnatal care assists the policy makers to design, justify and implement appropriate interventions. The current study aimed to analyse the factors associated with utilisation of postnatal care services by mothers in Nepal based on the data from Nepal Demographic and Health Survey (NDHS) 2011. Methods: This study utilised the data from NDHS 2011. The association between utilisation of at least one postnatal care visit (within 6 weeks of delivery) and immediate postnatal care (within 24 hours of delivery) with selected factors was examined by using Chi-square test (?2), followed by multiple logistic regression.Result: Of the 4079 mothers, 43.2% reported attending postnatal care within the first six weeks of birth, while 40.9% reported attending immediate postnatal care. Mothers who were from urban areas, from rich families, who were educated, whose partners were educated, who delivered in a health facility, who had attended a four or more antenatal visits, and whose delivery was attended by a skilled attendant were more likely to report attending at least one postnatal care visit. On the other hand, mothers who reported agricultural occupation, and whose partners performed agricultural occupation were less likely to have attended at least one postnatal care visit. Similarly, mothers who were from the urban areas, from rich families, who were educated, whose partners were educated, who had attended four or more antenatal visits, who delivered in a health facility and had delivered in the presence of a skilled birth attendant were more likely to report attending immediate postnatal care. Mothers who reported agricultural occupation, and whose partners performed agricultural occupation were less likely to attend immediate postnatal care. Conclusion: The majority of postnatal mothers in Nepal did not seek postnatal care. Increasing utilisation of the recommended four or more antenatal visits, delivery at health facility and increasing awareness and access to services through community-based programs especially for the rural, poor, and less educated mothers may increase postnatal care attendance in Nepal

Impactos ambientales sobre la salud respiratoria de los niños. Carga global de las enfermedades respiratorias pediátricas ligada al ambiente [Environmental impacts on the respiratory health of children: Global burden of paediatric respiratory diseases l

The child's respiratory system is a primary target for air pollutants, including tobacco smoke, biomass fuels and pollution from mobile and fixed sources. Children are, in general more susceptible to the effects of air pollutants; however, individual susceptibility also plays a role. Exposure to pollutants in early life decrease lung growth and results in reduced lung function. The range of respiratory illnesses with an environmental contribution includes: acute viral and bacterial lower respiratory infections; otitis media; asthma and chronic respiratory diseases. This review presents an overview of the identified risks posed by the environment to children's health and their health consequences

Moderate-to-severe anaemia among children aged 6–59 months in Nepal: An analysis from Nepal Demographic and Health Survey, 2011

AbstractIntroduction Anaemia among children is one of the major nutrition-related morbidities in developing countries. Surveillance of moderate-to-severe anaemia is recommended for the assessment of burden of anaemia in countries with high burden of anaemia. The objective of this study was to identify the factors associated with moderate-to-severe anaemia among the children aged 6–59 months in Nepal based on Nepal Demographic and Health Survey (NDHS) 2011. Methods This study used the dataset from the NDHS 2011. The information of last-born children whose haemoglobin was measured during the survey was used for analysis in this study. The factors associated with moderate-to-severe anaemia among children were examined using Chi-square test and logistic regression. Complex Sample Analysis was used to account for the study design and sampling. Results Of the 1605 last-born children aged 6–59 months, 343 (odds ratio (OR) 20.4%; 95% confidence interval (CI) 17.9–23.2%) had moderate-to-severe anaemia. Almost half (49.1%) of the children had some degree of anaemia. Mothers’ education, anaemia, ethnicity and children's age were significantly associated with moderate-to-severe anaemia among children. The mothers, who had no education (OR 3.362; 95% CI 1.485–7.611), who were suffering from anaemia (OR 3.278; 95% CI 1.884–5.704) and who were from disadvantaged Dalit ethnic groups (OR 1.739; 95% CI 1.133–2.669) were more likely to have their infants with anaemia. Similarly younger infants aged 6–11 months were more likely (OR 3.477; 95% CI 2.412–5.012) to suffer from anaemia. Conclusion There was comparatively a high prevalence of anaemia in children aged 6–59 months. Proper treatment for mothers’ anaemia with special attention on less educated and from disadvantaged ethnic groups will help reduce the anaemic status in children

Proportion (%) optimum thermal care among the children born in home, Nepal 2011 (N = 2464).

<p>The percentages presented for the thermal care are the weighted and cluster sampling adjusted percentage which differs from the crude percentage. The proportion of thermal care practice in each category are the row percent. The number of missing values may vary for each variable. # the number and percent reported are unweighted for the independent variables.</p

Thermal care practices among Nepalese Mothers (N = 2464).

<p>Thermal care practices among Nepalese Mothers (N =  2464).</p