A Multilevel Analysis to Determine the Factors Associated with Institutional Delivery in Nepal: Further Analysis of Nepal Demographic and Health Survey 2016

Abstract

Background: One out of two neonatal deaths and 2 out of 5 maternal deaths occur at home in Nepal. An essential intervention in reducing maternal mortality and neonatal death is institutional delivery. The objective of this study was to find out the external environmental, predisposing, and enabling factors associated with the use of institutional delivery care in Nepal. Methods: Data from Nepal Demographic and Health Surveys (NDHS) 2016 was used to estimate socio-economic, provincial, and use of media differentials with institutional delivery under the Andersen behavioral model framework using multilevel regression analysis. Results: More than half of the women (60.9%) among 3899 women with last birth had their babies delivered in a health facility. In the multilevel logistic regression analysis, we found that women from province 2 (OR = 0.47 95%CI: 0.28-0.79) were significantly less likely to deliver in health institutions, and province 7 (OR = 1.76, 95%CI: 1.05-2.94) were significantly more likely deliver in a health institution. Age (OR = 0.94, 95%CI: 0.92-0.95) was also significantly associated with the place of delivery. Women with higher education (OR = 3.17, 95%CI: 2.09-4.81) were most likely to go for institutional delivery. The odds of women opting for institutional delivery were 3 folds more for those who had visited Antenatal Care (ANC) 4 or more times compared to those who did not. Conclusion: The results highlight the need for governments and health care providers to emphasize the promotion of institutional delivery and ANC visits as per protocol with a special focus on underprivileged communities. The use of multi-media is a vital strategy to promote the use of institutional delivery services.

Multilevel analysis of factors associated with utilization of institutional delivery in Ethiopia

“…The independent variables included in this study were chosen based on past research and extant literature. 4 , 12 These include the age of the women at birth, place of residence, wealth index, religion, women’s educational level, current marital status, number of antenatal care visits, pregnancy complications, and husband/partner’s educational level.…”

“… 3 According to the United Nations International Children’s Emergency Fund (UNICEF), every day 800 mothers and 2700 babies die as a result of complications during pregnancy and childbirth, according to UNICEF data from 2015. 4 In 2015, the MMR in underdeveloped nations was 239 pregnant women per 100,000 live births, compared to 12 in industrialized countries. The number of women giving birth was high at the end of 2015, and over 303,000 women died during pregnancy, with almost all deaths occurring in low-resource areas and the majority being preventable.…”

“…Between 2014 and 2019, it is anticipated that about 81% of all deliveries took place in the presence of competent birth attendants, compared to 60% from 2000 to 2006. 4 …”

Determinants of institutional maternity services utilization in Myanmar

“…The exposure variables were divided into ‘institutional facility availability and accessibility’ and ‘population characteristics’ based on Andersen’s healthcare utilization model [ 22 ]. Regarding the institutional facility availability and accessibility, many studies have found that the chance of institutional delivery by trained health personnel is lower for women who live in a rural area because of less convenient or affordable access to a healthcare facility, and norms that may encourage home delivery by a traditional birth attendant (TBA) [ 19 , 25 , 32 , 33 ]. Moreover, other studies have identified the cost of travel and care as barriers to institutional delivery [ 19 , 32 , 34 ].…”

“…Studies from developed and developing countries have applied the Andersen model, such as the United States [ 23 ], Nepal [ 24 , 25 ], Nigeria [ 26 ], and Pakistan [ 27 ] as a framework for conducting research about health service utilization. Thus, it can be expected that the Andersen model is also applicable to a country like ‘Myanmar’ which is not radically different from other developing countries in the region (e.g., Nepal).…”