Karuna Foundation Nepal , Kathmandu , Nepal.
Nepal Health Sector Support Program, Ministry of Health and Population , Kathmandu , Nepal.
Front Public Health. 2015 Aug 14;3:197. doi: 10.3389/fpubh.2015.00197. eCollection 2015.
World Health Organization recommends at least four pregnancy check-ups for normal pregnancies. Ministry of Health and Population Nepal has introduced various strategies to promote prenatal care and institutional delivery to reduce maternal and child deaths. However, maternal health service utilization is low in some selected socio-economic and ethnic groups. Hence, this study aims to assess barriers to the recommended four antenatal care (4ANC) visits in eastern Nepal.
A cross-sectional quantitative study was conducted in Sunsari district. A total of 372 randomly selected women who delivered in the last year preceding the survey were interviewed using a semi-structured questionnaire. Bivariate and multivariate logistic regression analysis was carried out to identify barriers associated with 4ANC visits.
More than two-third women (69%) attended at least 4ANC visits. The study revealed that women exposed to media had higher chance of receiving four or more ANC visits with an adjusted odds ratio (aOR = 3.5, 95% CI: 1.2-10.1) in comparison to women who did not. Women from an advantaged ethnic group had more chance of having 4ANC visits than respondents from a disadvantaged ethnic group (aOR = 2.4, 95% CI: 2.1-6.9). Similarly, women having a higher level of autonomy were nearly three times more likely (aOR = 2.9, 95% CI: 1.5-5.6) and richer women were twice (aOR = 2.3, 95% CI: 1.1-5.3) as likely to have at least 4ANC visits compared to women who had a lower level of autonomy and were economically poor.
Being from disadvantaged ethnicity, lower women's autonomy, poor knowledge of maternal health service and incentive upon completion of ANC, less media exposure related to maternal health service, and lower wealth rank were significantly associated with fewer than the recommended 4ANC visits. Thus, maternal health programs need to address such socio-cultural barriers for effective health care utilization.
世界卫生组织建议正常妊娠至少进行四次产前检查。尼泊尔卫生和人口部已经推出了各种策略来促进产前保健和机构分娩，以降低母婴死亡。然而，在一些选定的社会经济和族裔群体中，孕产妇保健服务的利用率仍然较低。因此，本研究旨在评估尼泊尔东部推荐的四次产前护理（ANC）就诊的障碍。
本研究采用横断面定量研究方法，在桑萨里区进行。共采访了 372 名在调查前一年分娩的随机选择的妇女，使用半结构式问卷。进行了二变量和多变量逻辑回归分析，以确定与 4ANC 就诊相关的障碍。
超过三分之二的妇女（69%）至少接受了 4 次 ANC 就诊。研究表明，与未接触媒体的妇女相比，接触媒体的妇女接受四次或更多 ANC 就诊的可能性更高，调整后的优势比（aOR）为 3.5（95%CI：1.2-10.1）。来自优势族裔群体的妇女比来自劣势族裔群体的妇女更有可能接受 4ANC 就诊（aOR=2.4，95%CI：2.1-6.9）。同样，自主权较高的妇女接受至少 4 次 ANC 就诊的可能性几乎高出三倍（aOR=2.9，95%CI：1.5-5.6），而较富裕的妇女接受至少 4 次 ANC 就诊的可能性是自主权较低和经济贫困妇女的两倍（aOR=2.3，95%CI：1.1-5.3）。
来自劣势族裔、妇女自主权较低、对产妇保健服务知识不足、ANC 完成后激励措施较少、与产妇保健服务相关的媒体接触较少以及财富等级较低与少于推荐的 4 次 ANC 就诊显著相关。因此，孕产妇保健计划需要解决这些社会文化障碍，以实现有效的医疗保健利用。
