Cargando…

Trends and Inequalities in Use of Maternal Health Care Services in Nepal: Strategy in the Search for Improvements

BACKGROUND: Nepal has made significant progress against the Millennium Development Goals for maternal and child health over the past two decades. However, disparities in use of maternal health services persist along geographic, economic, and sociocultural lines. METHODS: Trends and inequalities in t...

Descripción completa

Detalles Bibliográficos
Autores principales: Mehata, Suresh, Paudel, Yuba Raj, Dariang, Maureen, Aryal, Krishna Kumar, Lal, Bibek Kumar, Khanal, Mukti Nath, Thomas, Deborah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541802/
https://www.ncbi.nlm.nih.gov/pubmed/28808658
http://dx.doi.org/10.1155/2017/5079234
_version_ 1783254880703479808
author Mehata, Suresh
Paudel, Yuba Raj
Dariang, Maureen
Aryal, Krishna Kumar
Lal, Bibek Kumar
Khanal, Mukti Nath
Thomas, Deborah
author_facet Mehata, Suresh
Paudel, Yuba Raj
Dariang, Maureen
Aryal, Krishna Kumar
Lal, Bibek Kumar
Khanal, Mukti Nath
Thomas, Deborah
author_sort Mehata, Suresh
collection PubMed
description BACKGROUND: Nepal has made significant progress against the Millennium Development Goals for maternal and child health over the past two decades. However, disparities in use of maternal health services persist along geographic, economic, and sociocultural lines. METHODS: Trends and inequalities in the use of maternal health services in Nepal between 1994 and 2011 were examined using four Nepal Demographic and Health Surveys (NDHS), nationally representative cross-sectional surveys conducted by interviewing women who gave birth 3–5 years prior to the survey. Sociodemographic disparities in maternal health service utilization were measured. Rate difference, rate ratios, and concentration index were calculated to measure income inequalities. FINDINGS: The percentage of mothers that received four antenatal care (ANC) consultations increased from 9% to 54%, the institutional delivery rate increased from 6% to 47%, and the cesarean section (C-section) rate increased from 1% in 1994 to 6% in 2011. The ratio of the richest and the poorest quintile mothers for use of four ANC, institutional delivery, and C-section delivery were 5.08 (95% CI: 3.82–6.76), 9.00 (95% CI: 6.55–12.37), and 9.37 (95% CI: 4.22–20.83), respectively. However, inequality is reducing over time; for the use of four ANC services, the concentration index fell from 0.60 (95% CI: 0.56–0.64) in 1994–1996 to 0.31 (95% CI: 0.29–0.33) in 2009–2011. For institutional delivery, the concentration index fell from 0.65 (95% CI: 0.62–0.70) to 0.40 (95% CI: 0.38–0.40) between 1994–1996 and 2009–2011. For C-section deliveries, an increase in concentration index was observed, 0.64 (95% CI: 0.51–0.77); 0.76 (95% CI: 0.64–0.88); 0.77 (95% CI: 0.71–0.84); and 0.66 (95% CI: 0.60–0.72) in the periods 1994–1996, 1999–2001, 2004–2006, and 2009–2011, respectively. All sociodemographic variables were significant predictors of use of maternal health services, out of which maternal education was the most powerful. CONCLUSION: To increase equitable use of maternal health services in Nepal there is a need to strengthen the health system to increase access to and utilization of services among poorer women, those with less education, and those living in remote areas. Beyond the health sector stronger efforts are needed to tackle the root causes of health inequality, reduce poverty, increase female education, eradicate caste/ethnicity based social discrimination, and invest in the development of remote areas.
format Online
Article
Text
id pubmed-5541802
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Hindawi
record_format MEDLINE/PubMed
spelling pubmed-55418022017-08-14 Trends and Inequalities in Use of Maternal Health Care Services in Nepal: Strategy in the Search for Improvements Mehata, Suresh Paudel, Yuba Raj Dariang, Maureen Aryal, Krishna Kumar Lal, Bibek Kumar Khanal, Mukti Nath Thomas, Deborah Biomed Res Int Research Article BACKGROUND: Nepal has made significant progress against the Millennium Development Goals for maternal and child health over the past two decades. However, disparities in use of maternal health services persist along geographic, economic, and sociocultural lines. METHODS: Trends and inequalities in the use of maternal health services in Nepal between 1994 and 2011 were examined using four Nepal Demographic and Health Surveys (NDHS), nationally representative cross-sectional surveys conducted by interviewing women who gave birth 3–5 years prior to the survey. Sociodemographic disparities in maternal health service utilization were measured. Rate difference, rate ratios, and concentration index were calculated to measure income inequalities. FINDINGS: The percentage of mothers that received four antenatal care (ANC) consultations increased from 9% to 54%, the institutional delivery rate increased from 6% to 47%, and the cesarean section (C-section) rate increased from 1% in 1994 to 6% in 2011. The ratio of the richest and the poorest quintile mothers for use of four ANC, institutional delivery, and C-section delivery were 5.08 (95% CI: 3.82–6.76), 9.00 (95% CI: 6.55–12.37), and 9.37 (95% CI: 4.22–20.83), respectively. However, inequality is reducing over time; for the use of four ANC services, the concentration index fell from 0.60 (95% CI: 0.56–0.64) in 1994–1996 to 0.31 (95% CI: 0.29–0.33) in 2009–2011. For institutional delivery, the concentration index fell from 0.65 (95% CI: 0.62–0.70) to 0.40 (95% CI: 0.38–0.40) between 1994–1996 and 2009–2011. For C-section deliveries, an increase in concentration index was observed, 0.64 (95% CI: 0.51–0.77); 0.76 (95% CI: 0.64–0.88); 0.77 (95% CI: 0.71–0.84); and 0.66 (95% CI: 0.60–0.72) in the periods 1994–1996, 1999–2001, 2004–2006, and 2009–2011, respectively. All sociodemographic variables were significant predictors of use of maternal health services, out of which maternal education was the most powerful. CONCLUSION: To increase equitable use of maternal health services in Nepal there is a need to strengthen the health system to increase access to and utilization of services among poorer women, those with less education, and those living in remote areas. Beyond the health sector stronger efforts are needed to tackle the root causes of health inequality, reduce poverty, increase female education, eradicate caste/ethnicity based social discrimination, and invest in the development of remote areas. Hindawi 2017 2017-07-20 /pmc/articles/PMC5541802/ /pubmed/28808658 http://dx.doi.org/10.1155/2017/5079234 Text en Copyright © 2017 Suresh Mehata et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Mehata, Suresh
Paudel, Yuba Raj
Dariang, Maureen
Aryal, Krishna Kumar
Lal, Bibek Kumar
Khanal, Mukti Nath
Thomas, Deborah
Trends and Inequalities in Use of Maternal Health Care Services in Nepal: Strategy in the Search for Improvements
title Trends and Inequalities in Use of Maternal Health Care Services in Nepal: Strategy in the Search for Improvements
title_full Trends and Inequalities in Use of Maternal Health Care Services in Nepal: Strategy in the Search for Improvements
title_fullStr Trends and Inequalities in Use of Maternal Health Care Services in Nepal: Strategy in the Search for Improvements
title_full_unstemmed Trends and Inequalities in Use of Maternal Health Care Services in Nepal: Strategy in the Search for Improvements
title_short Trends and Inequalities in Use of Maternal Health Care Services in Nepal: Strategy in the Search for Improvements
title_sort trends and inequalities in use of maternal health care services in nepal: strategy in the search for improvements
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541802/
https://www.ncbi.nlm.nih.gov/pubmed/28808658
http://dx.doi.org/10.1155/2017/5079234
work_keys_str_mv AT mehatasuresh trendsandinequalitiesinuseofmaternalhealthcareservicesinnepalstrategyinthesearchforimprovements
AT paudelyubaraj trendsandinequalitiesinuseofmaternalhealthcareservicesinnepalstrategyinthesearchforimprovements
AT dariangmaureen trendsandinequalitiesinuseofmaternalhealthcareservicesinnepalstrategyinthesearchforimprovements
AT aryalkrishnakumar trendsandinequalitiesinuseofmaternalhealthcareservicesinnepalstrategyinthesearchforimprovements
AT lalbibekkumar trendsandinequalitiesinuseofmaternalhealthcareservicesinnepalstrategyinthesearchforimprovements
AT khanalmuktinath trendsandinequalitiesinuseofmaternalhealthcareservicesinnepalstrategyinthesearchforimprovements
AT thomasdeborah trendsandinequalitiesinuseofmaternalhealthcareservicesinnepalstrategyinthesearchforimprovements