Sociodemographic correlates of antenatal care visits in Nepal: results from Nepal Demographic and Health Survey 2016

Abstract

Background: Good quality antenatal care visits are crucial to reduce maternal mortality and improve overall maternal and neonatal health outcomes. A previous study on antenatal care visits analyzed the nationally representative data of 2011; however, no studies have been conducted recently in Nepal. Therefore, we analyzed the sociodemographic correlates of the frequency and quality of antenatal care among Nepalese women from the nationally representative data of 2016. Methods: We analyzed data obtained from the Nepal Demography Health Survey (2016) on antenatal care for 2761 women who had one or more births in the past three years. Our study defined 'good quality antenatal care' as at least a 75% score on a composite metric which was obtained by adding the weighted scores assigned to the twelve recommended components of antenatal care. We analyzed the factors associated with the frequency and quality of antenatal care by using multiple Poisson regression and multiple logistic regression. Results: While 70% of the Nepalese women surveyed had at least four antenatal care visits, only 21% of these women received good-quality antenatal care. We found that the educated women (APR: 1.12; CI: 1.05-1.19) and the women of rich wealth index (APR: 1.27; CI: 1.18-1.37) were more likely to receive a higher number of antenatal visits. In contrast, women living in rural areas (APR: 0.92; CI: 0.87-0.98), and those who had more than two children (APR: 0.88; CI: 0.83-0.93) were less likely to receive a higher number of antenatal visits. Regarding the quality of antenatal care, educated women (AOR: 1.51; CI: 1.09-2.08), women who had educated husbands (AOR: 2.11; CI: 1.38-3.22), women of rich wealth index (AOR: 1.58; CI: 1.13-2.20) and women who had intended pregnancy (APR: 1.69; CI: 1.23-2.34), were more likely to receive good-quality antenatal care. Conclusions: Observing a wide variation in the coverage of different components of antenatal care, concerned stakeholders could tailor the interventions by focusing on components with lower use. Because we found an association of myriad sociodemographic factors with the frequency and quality of antenatal care, targeted interventions are necessary.

Patterns and determinants of effective coverage of routine maternal and newborn health visits in Nepal: Analysis of the 2016 Demographic and Health Survey

“…Poor EC of MNH visits identified in the current study are consistent with the studies conducted in Bangladesh [54], Cambodia [55], and other LMICs of South Asia and Sub Saharan Africa [18,46]. Studies conducted in Nepal reported poor quality of ANC [48] and had low uptake of recommended antenatal interventions (e.g., ANC counselling or iron or tetanus toxoid injections) [56]. An analysis of multi-country data revealed low EC of facility delivery [57] and 4ANC visits and PNC visit [58] despite high contact coverage of respective MNH visits.…”

“…Although there are no gold standards of cut-off points for categorisation of poor or good effective coverage, this study took reference cut-off point of 0.80 to a previous study undertaken in Kenya [47] and Nepal [48]. Then scores were dichotomised into poor EC (if scores >0 and ≤0.8) and good EC (if scores >0.8) to identify the determinants of good EC of MNH visits.…”

Extent of Received Antenatal Care Components in Ethiopia: A Community-Based Panel Study

“…In the same way, previous studies showed that as education increases, number of received ANC content also increases. 9 , 22 , 42 , 50 , 51 , 55 Relatively affordable and accessible health information for educated women compared to those who never attended schools may explain the associations. 56 Furthermore, education fosters maternal healthcare awareness, appropriate need-based services utilization, 17 , 20 , 57 household maternal decision-making ability, 57 autonomy on their health, 58 new values and attitudes that favor modern health care.…”

“…Furthermore, we dichotomized the received ANC content as those who received greater than or equal to 75 percentiles as received adequate ANC content and less than as inadequate. 42 , 43 …”

“…Furthermore, we dichotomized the received ANC content as those who received greater than or equal to 75 percentiles as received adequate ANC content and less than as inadequate. 42,43 The study also included individual-level factors like maternal age (15-19, 20-24, 25-29, 30-34, 35-39, 40-49), educational status (never attended, primary, secondary, technical or vocational, and higher), marital status (others or married), a partner has other wives or women (yes or no), ever been pregnant (yes or no), current pregnancy desired (then, later or not at all), birth events (primipara, multipara, grand-multipara), and partner encouraged you to attend ANC (yes or no). Additionally, community-level factors were included, such as place of residence (urban or rural), regions (Tigray, Afar, Amhara, Oromia, SNNP, Addis Ababa), wealth quartile (lowest, lower, middle, higher, highest), and structural quality of care for ANC (ie, availability of ANC guideline, ANC checklist, blood pressure apparatus, hemoglobin test, urine dipstick protein test, iron tablets, folic acid tablets, tetanus toxoid vaccine, and insecticide-treated bed net) 44 as explanatory variables.…”