Continuity of care and its determinants of routine maternal and newborn health visits in Nepal: Evidence from a nationally representative household survey

Abstract

Background Maternal and newborn health (MNH) is a priority health issue in Nepal, has high maternal and neonatal deaths. Maternal and neonatal deaths can be prevented through uptake of essential antenatal, intrapartum, and postnatal interventions received during routine MNH visits. Not all women, however, receive all recommended routine visits across the MNH Continuum of Care (CoC) in Nepal. This study examined the patterns and determinants of (dis)continuity of care across the MNH continuum. Methods The study included 1,978 women aged 15–49 years who had a live birth in the two years preceding the survey. Data were derived from the Nepal Demographic and Health Survey (NDHS) 2016. The outcome variable was (dis)continuity of care at different stages of MNH visits (at least four antenatal care (4ANC) visits, institutional delivery, and postnatal care (PNC) visit). Several structural, intermediary and health system explanatory variables were included in the analysis. Multinomial logistic regression analysis was conducted, and the magnitude of (dis)continuity of care was reported as relative risk ratios (RR) with 95% confidence intervals (CIs). The statistical significance level was set p<0.05. Results More than two-in-five (41%) women in Nepal received all three MNH visits across the CoC. There was high risk of discontinuity of care during months or weeks prior to childbirth or around childbirth. Higher risk of discontinuation across the CoC was reported among women of disadvantaged ethnic groups, lower wealth status and illiterate. Similarly, women who speak Bhojpuri, provinces six and seven, who had higher birth order (≥4), who involved in agricultural sector, had unwanted last birth had higher risk of discontinuation of MNH visits. Women did not complete all MNH visits if they had poor awareness on health mother groups and if they perceived problem of not having female healthcare providers. Conclusions Women had poor completion of all routine MNH visits. High discontinuation was observed among disadvantaged groups across the COC. Regular monitoring using the composite indicator of continuity of care through routine health management information system is required. Program approaches should focus on disadvantaged women to improve the completion of routine MNH visits and uptake of essential interventions.

Clustering of child deaths among families in low and middle‐income countries: A meta‐analysis

“…The role of antenatal care is critical since pregnancy outcomes differ for women with and without prenatal care 52 . Among Indian women, antenatal and postnatal care decisions are influenced by their socio‐economic, cultural, and individual characteristics 53,54 and by the availability and accessibility of the health services 55 . It has been shown that the utiliztion of antenatal care services may result in the utilization of other maternal health‐related services such as institutional delivery and advice regarding post‐delivery complications 56 .…”

“…52 Among Indian women, antenatal and postnatal care decisions are influenced by their socio-economic, cultural, and individual characteristics 53,54 and by the availability and accessibility of the health services. 55 It has been shown that the utiliztion of antenatal care services may result in the utilization of other maternal health-related services such as institutional delivery and advice regarding post-delivery complications. 56 The clustering of child deaths can be greatly reduced by intervening with proper antenatal care coverage, as it influences the use of healthcare by women later on.…”

Socio-cultural factors affecting maternal health system in District Buner, Khyber Pakhtunkhwa Pakistan

“…Low household incomes, high illiteracy, lack of awareness, and various cultural factors have been reported in studies from India and Pakistan as contributing to the low utilization of maternity facilities (Shariff & Singh 2002, Shaikh & Hatcher 2005. Similarly, research in Ethiopia has revealed that women's sociodemographic characteristics, cultural background, and proximity to healthcare facilities all play pivotal roles in determining the utilization of maternal health services (Mekonnen 2003).…”

Utilization of Maternal Health Care Services In an Urban Slum of Bangalore- A Cross-Sectional Study

“…6 Inadequate accessibility and under-utilization of healthcare services are major reasons for poor maternal health in the developing countries which in turn is due to many factors like low levels of income, illiteracy and ignorance, a bundle of traditional factors on one hand and substandard and inadequate public health services on the other. 4,7,8,9 This leads to increase in MMR and also child deaths.…”

“…13 Several factors influence this model and determine the utilization of maternal health care services like socio-economic factors, availability, accessibility, affordability of health care services, women's autonomy in the household, women's knowledge, family attitudes, beliefs & culture. 4,8,9,14,15 This study was conducted to assess the utilization of maternal health care services and factors which influence them, in an urban slum; as this is the neglected region in an urban area.…”