Two thirds of the most disadvantaged Dalit population of Nepal still do not deliver in health facilities despite impressive success in maternal health

Chaurasiya, Surendra Prasad; Pravana, Nilesh Kumar; Khanal, Vishnu; Giri, Dhiraj

doi:10.1371/journal.pone.0217337

Cited by 11 publications

(14 citation statements)

References 19 publications

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“…Consistent with our study, socially disadvantaged castes of other groups were less likely to have adequate ANC compared to the advantaged castes in a similar study conducted in India [30]. Such findings may be due to a low level of awareness among disadvantaged ethnic groups; a study in the most disadvantaged ethnic group in Nepal revealed that the women in this group viewed antenatal visits as unnecessary [42], thinking pregnancy as a normal phenomenon that do not require health care visitation. Further, we found that increases in parity were associated with a decreased likelihood of receiving good quality ANC.…”

Section: Components and Quality Of Ancsupporting

confidence: 87%

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

Adhikari

Chalise

Bista

et al. 2020

BMC Pregnancy Childbirth

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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.

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Section: Components and Quality Of Ancsupporting

confidence: 87%

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

Adhikari

Chalise

Bista

et al. 2020

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

show abstract

“…Consistent with our study, socially disadvantaged castes of other groups were less likely to have adequate ANC compared to the advantaged castes in a similar study conducted in India [27]. This may be due to low level of awareness among disadvantaged ethnic groups; a study in the most disadvantaged ethnic group in Nepal revealed that the women in this group viewed antenatal visits as unnecessary [39]. Further, we found that increases in parity were associated with a decreased likelihood of receiving good quality ANC.…”

Section: Components and Quality Of Ancsupporting

confidence: 86%

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

Adhikari¹,

Chalise

Bista

et al. 2020

Preprint

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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.Conclusion: Due to 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.

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“…A review study from the neighboring country India also supports these ndings with an argument that the COVID-19 pandemic will push a signi cant number of the population below the poverty line, creating higher socioeconomic inequalities that will have further detrimental effects on health and health care utilization status [41]. In Nepal, the vulnerable population is composed of Dalits and marginalized population, in addition to women, children, and older adults who are already suffering from hunger, poor health, discrimination, and political powerlessness (during normal situation); these disadvantaged groups have suffered disproportionately from disasters such as earthquakes, oods and now the current pandemic [42][43][44].…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on Health Services Utilization in Province-2 of Nepal: A Qualitative Study Among Community Members and Stakeholders

Singh

Sunuwar

Shah

et al. 2020

Preprint

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Background The COVID-19 pandemic is posing unprecedented challenges and threats to the health care system, particularly affecting the effective delivery of essential health services in resource-poor countries such as Nepal. This study aims to explore community perceptions of COVID-19 and their experiences towards health services utilization during the pandemic in Province-2 of Nepal. MethodsThe semi-structured qualitative interviews were conducted among purposively selected participants (n=41) from a mix of rural and urban settings in all districts (n =8) in Province 2 of Nepal. Virtual interviews were conducted between July and August 2020 in local languages. The data were analyzed using thematic network analysis in NVivo 12 Pro. ResultsThe findings of this research are categorized into four global themes: i) Community and stakeholders’ perceptions towards COVID-19; ii) Impact of COVID-19 and lockdown on health services delivery; iii) Community perceptions and experiences of health services during COVID-19; and, iv) COVID-19: testing, isolation, and quarantine services. Most participants shared their experience of being worried and fearful about COVID-19 and reported a lack of awareness, misinformation, and stigma as major factors contributing to the spread of COVID-19. Maternity services, immunization, and supply of essential medicine were found to be the most affected areas of health care delivery during the lockdown. Participants reported that the interruptions of health services were mostly due to the closure of health services at local health facilities, limited involvement of private health sectors during the pandemic, fears of COVID-19 transmission among health workers and within health centers, and disruption of transportation services. In addition, the participants expressed frustrations on poor testing, isolation, and quarantine services related to COVID-19, and poor accountability from governments at all levels towards health services management during the COVID-19 pandemic. ConclusionsThis study found that essential health services were severely affected during the COVID-19 pandemic in all districts of Province-2. It is essential to expand the service coverage and its quality in addition to increasing public-private sector engagement to ensure the essential health services are utilized by the population.

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Two thirds of the most disadvantaged Dalit population of Nepal still do not deliver in health facilities despite impressive success in maternal health

Cited by 11 publications

References 19 publications

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

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

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

Impact of COVID-19 on Health Services Utilization in Province-2 of Nepal: A Qualitative Study Among Community Members and Stakeholders

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