Universal coverage of the first antenatal care visit but poor continuity of care across the maternal and newborn health continuum among Nepalese women: analysis of levels and correlates

Abstract

Background Routine maternity care visits (MCVs) such as antenatal care (ANC), institutional delivery, and postnatal care (PNC) visits are crucial to utilisation of maternal and newborn health (MNH) interventions during pregnancy-postnatal period. In Nepal, however, not all women complete these routine MCVs. Therefore, this study examined the levels and correlates of (dis)continuity of MCVs across the antenatal-postnatal period. Methods We conducted further analysis of the 2016 Nepal Demographic and Health Survey. A total of 1,978 women aged 15–49 years, who had live birth two years preceding the survey, were included in the analysis. The outcome variable was (dis)continuity of routine MCVs (at least four ANC visits, institutional delivery, and PNC visit) across the pathway of antennal through to postnatal period. Independent variables included several social determinants of health under structural, intermediary, and health system domains. Multinomial logistic regression was conducted to identify the correlates of routine MCVs. Relative risk ratios (RR) were reported with 95% confidence intervals at a significance level of p<0.05. Results Approximately 41% of women completed all routine MCVs with a high proportion of discontinuation around childbirth. Women of disadvantaged ethnicities, from low wealth status, who were illiterate had higher RR of discontinuation of MCVs (compared to completion of all MCVs). Similarly, women who speak Bhojpuri, from remote provinces (Karnali and Sudurpaschim), who had a high birth order (≥4), who were involved in the agricultural sector, and who had unwanted last birth had a higher RR of discontinuation of MCVs. Women discontinued routine MCVs if they had poor awareness of health mother-groups and perceived the problem of not having female providers. Conclusions Routine monitoring using composite coverage indicators is required to track the levels of (dis)continuity of routine MCVs at the maternity care continuum. Strategies such as raising awareness on the importance of maternity care, care provision from female health workers could potentially improve the completion of MCVs. In addition, policy and programmes for continuity of maternity care are needed to focus on women with socioeconomic and ethnic disadvantages and from remote provinces.

Spatial distribution and associated factors of dropout from health facility delivery after antenatal booking in Ethiopia: a multi-level analysis

“…It is also similar to studies done in a multi-county study in 49 and 28 countries including Africa [ 5 , 14 ]. The result was again supported by a study conducted in Nepal [ 48 ]. Studies in Pakistan and Cambodia also showed the same finding [ 8 , 53 ].…”

“…Again the finding of this study was lower than a study conducted in Tanzania (53.81%) [ 42 ], Kenya (66.30%) [ 43 ], Uganda (48%) [ 44 ], Nigeria (38.1%) [ 34 ], Zambia (42.70%) [ 45 ], Guinea (74%) [ 46 ], and rural Gahna (38.1%) [ 47 ]. The finding was also lower as compared to a study conducted in 28 African countries (44%) [ 14 ] and studies conducted in different parts of Nepal which was ranged from 39 to 58% [ 12 , 13 , 48 ]. The possible reason for this difference may be due to the fact that the first three studies in Ethiopia were conducted in smaller sample sizes and time variation may be attributed to the difference.…”

Completion of the maternal and neonatal continuum of care service utilisation and determining factors in Assosa Zone, North Western Ethiopia

“…Continuum of care in maternal and neonatal service delivery is in uenced by diverse factors at various levels in India, Napal, Egypt, Uganda and Ethiopia [21,26,32,[34][35]. Economic status, ethnicity, education, gender, religion and social in-equalities are the major factors for utilisation MNH CoC services [34,36].…”

“…Place of residence, maternal age at childbirth, parity and women's exposure to mass media, and maternal health messages were the major factors for underutilisation of the services [34]. In Napal underutilisation or discontinuation of MNH CoC happened among women of disadvantaged ethnicities, low wealth status, illiterate, had high birth order, involved in agricultural sector, had unwanted last birth order and had poor awareness of health mother-groups [21]. In Egypt MNH CoC service utilisation affected by women's age, educational level of both partners, birth orders and exposure to mass media [32].…”

Input, process, and output factors contributing to quality of antenatal care services: a scoping review of evidence

“…Routine ANC visits encourage women to take recommended interventions for healthy pregnancies and newborns and reduce adverse pregnancy outcomes. For example, evidence suggests that women who complete recommended ANC visits are more likely to give birth at a health facility and complete postnatal care (PNC) and give childbirth assisted by SBAs compared to a pregnant woman without ANC visits [ 17 , 18 ]. In addition, uptake of recommended ANC interventions requires better health facility readiness (e.g., provision of essential medicines, trained health workforces), delivery of interventions, and uptake by disadvantaged population groups [ 19 , 20 ].…”