Testing a scalable community-based approach to improve maternal and neonatal health in rural Nepal

Hodgins, Stephen; McPherson, Robert; Suvedi, B K; Shrestha, R B; Silwal, Ram Chandra; Ban, Bharat; Neupane, Sumanta; Baqui, Abdullah H

doi:10.1038/jp.2009.181

Cited by 25 publications

(34 citation statements)

References 9 publications

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“…In Bangladesh, Burkina Faso, and Eritrea, increased awareness and birth planning associates with increased utilization of SBA services (40–42). In contrast, two evaluation studies from Nepal suggest no association between increased birth preparedness and delivery at a health facility (43, 44). However, study design might account for such discrepancies.…”

Section: Discussionmentioning

confidence: 98%

Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study

Onta

Choulagai

Shrestha

et al. 2014

Global Health Action

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BackgroundAlthough skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care.DesignWe conducted 24 focus group discussions, 12 each with service users and service providers from different health institutions in mid- and far-western Nepal. All discussions examined the perceptions and experiences of service users and providers regarding barriers to skilled birth care and explored possible solutions to overcoming such barriers.ResultsOur results determined that major barriers to skilled birth care include inadequate knowledge of the importance of services offered by skilled birth attendants (SBAs), distance to health facilities, unavailability of transport services, and poor availability of SBAs. Other barriers included poor infrastructure, meager services, inadequate information about services/facilities, cultural practices and beliefs, and low prioritization of birth care. Moreover, the tradition of isolating women during and after childbirth decreased the likelihood that women would utilize delivery care services at health facilities.ConclusionsService users and providers perceived inadequate availability and accessibility of skilled birth care in remote areas of Nepal, and overall utilization of these services was poor. Therefore, training and recruiting locally available health workers, helping community groups establish transport mechanisms, upgrading physical facilities and services at health institutions, and increasing community awareness of the importance of skilled birth care will help bridge these gaps.

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Section: Discussionmentioning

confidence: 98%

Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study

Onta

Choulagai

Shrestha

et al. 2014

Global Health Action

View full text Add to dashboard Cite

show abstract

“…Raising awareness and help for birth plan also led to increased facility utilisation in other intervention studies conducted in Burkina Faso, Bangladesh and Eritrea 24–26. However, two prepost evaluation studies of birth preparedness in southern districts of Nepal reported that increased preparedness level was not significantly translated into increased facility delivery 27 28…”

Section: Discussionmentioning

confidence: 99%

Need factors for utilisation of institutional delivery services in Nepal: an analysis from Nepal Demographic and Health Survey, 2011

2014

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ObjectiveThis study aims to assess the role of need factors with respect to the utilisation of institutional delivery services in Nepal.DesignAn analytic study was conducted using a subset of 4079 ever married women from the 2011 Nepal Demographic and Health Survey, which utilised two-stage cluster sampling. Logistic regression with complex sample analysis was performed to evaluate the effects of antenatal care visits and birth preparedness activities on facility delivery.Outcome measuresFacility delivery.ResultsOverall facility delivery rate was low at 36.9% (95% CI 33.5% to 40.2%, SE 1.69). Only half (50.1%) of the women made four or more antenatal care visits while 62.9% (95% CI 59.9% to 65.8%, SE 1.51) did not indicate any of the four birth preparation activities. After adjusting for external, predisposing and enabling factors, women who made more than four antenatal care visits were five times more likely to deliver at a health facility when compared to those who paid no visit (adjusted OR 4.94, 95% CI 3.14 to 7.76). Similarly, the likelihood for facility delivery increased by 3.4-fold among women who prepared for at least two of the four activities compared to their counterparts who made no preparation (adjusted OR 3.41, 95% CI 2.01 to 5.58).ConclusionsThe perceived need, as expressed by the frequency of antenatal care visits and birth preparedness activities, plays an important role in institutional delivery service utilisation for Nepali women. These findings have implications for behavioural interventions to change their intention to deliver at a health facility.

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“…This is not surprising. The relationship between maternal literacy/education has been well-established in similar settings [29-32]. Therefore, educating mothers and primary care-givers of newborns will constitute an important avenue for interventions aimed at child survival.…”

Section: Discussionmentioning

confidence: 99%

Maternal and Antenatal Risk Factors for Stillbirths and Neonatal Mortality in Rural Bangladesh: A Case-Control Study

et al. 2013

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ObjectiveTo identify maternal and antenatal factors associated with stillbirths and neonatal deaths in rural Bangladesh.Study DesignA prospective cohort study is being conducted to evaluate a maternal and child nutrition program in rural Bangladesh. Cases were all stillbirths and neonatal deaths that occurred in the cohort between March 7, 2011 and December 30, 2011. Verbal autopsies were used to determine cause of death. For each case, four controls were randomly selected from cohort members alive at age 3-months. Multivariable logistic regression was used to identify factors associated with these deaths.ResultsOverall, 112 adverse pregnancy outcomes (44 stillbirths, 19/1,000 births; 68 neonatal deaths, 29/1,000 live births) were reported. Of the stillbirths 25 (56.8%) were fresh. The main causes of neonatal death were birth asphyxia (35%), sepsis (28%) and preterm birth (19%). History of bleeding during pregnancy was the strongest risk factor for stillbirths (adjusted odds ratio 22.4 [95% confidence interval 2.5, 197.5]) and neonatal deaths (adjusted odds ratio 19.6 [95% confidence interval 2.1, 178.8]). Adequate maternal nutrition was associated with decreased risk of neonatal death (adjusted odds ratio 0.4 [95% confidence interval 0.2, 0.8]).ConclusionsIdentifying high-risk pregnancies during gestation and ensuring adequate antenatal and obstetric care needs to be a priority for any community-based maternal and child health program in similar settings.

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Testing a scalable community-based approach to improve maternal and neonatal health in rural Nepal

Cited by 25 publications

References 9 publications

Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study

Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study

Need factors for utilisation of institutional delivery services in Nepal: an analysis from Nepal Demographic and Health Survey, 2011

Maternal and Antenatal Risk Factors for Stillbirths and Neonatal Mortality in Rural Bangladesh: A Case-Control Study

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