Paudel Yuba Raj, Jha Trishna, Mehata Suresh
FAIRMED Nepal, Lalitpur, Nepal.
National Open College, Lalitpur, Nepal.
Front Public Health. 2017 Sep 11;5:242. doi: 10.3389/fpubh.2017.00242. eCollection 2017.
The provision and uptake of quality and timely antenatal care (ANC) is an essential element of efforts to improve health outcomes for women and newborn babies. Antenatal consultations assist in early identification and treatment of complications during pregnancy. This study aimed to provide an information on distribution and inequalities in early initiation of ANC in Nepal.
The distribution and inequalities in the early initiation of ANC were examined using Nepal Demographic and Health Surveys 2011. Bivariate and multivariate logistic regression was used to assess inequalities.
Overall, 70% of the women had started their first ANC at 4 month or earlier. Among participants who had never attended school, just more than half (52%) received first ANC at 4 months or earlier, while majority of participants (97%) who had received higher education received first ANC at recommended time. Similarly, 89% of those from richest quintile and 48% of those from poorest quintile received first ANC at recommended time. In adjusted analysis, women from richest wealth quintile were significantly more likely to initiate ANC early (AOR: 3.74, 95% CI: 2.31-6.05) compared to the poorest. Similarly, women with higher level education were significantly more likely (AOR: 11.40, 95% CI: 5.05-25.73) to initiate ANC early compared to women who had never attended school. A significantly lower odds of early ANC take up was observed among madhesi other caste (AOR: 0.56, 95% CI: 0.35-0.90) compared to brahmin/chhetri women. Women whose pregnancy was unwanted were significantly less likely to attend first ANC at 4 months or early (AOR: 0.73, 95% CI: 0.58-0.93) in comparison to women whose pregnancy was wanted.
The differences in the recommended timing of initiation of ANC were evident among women with different educational, economic levels, and caste/ethnic groups. Rural women were less likely to have checkups as per guidelines. The findings suggest to a need of interventions to raise female education and improve economic status of households. Targeted interventions suitable to local context and culture are equally important. Increasing access to family planning methods and reduction of unwanted pregnancy can promote early ANC take up.
提供并接受高质量且及时的产前护理是改善妇女和新生儿健康状况的关键要素。产前咨询有助于在孕期早期识别并治疗并发症。本研究旨在提供尼泊尔产前护理早期开始情况的分布及不平等状况的相关信息。
利用2011年尼泊尔人口与健康调查来研究产前护理早期开始情况的分布及不平等状况。采用双变量和多变量逻辑回归来评估不平等情况。
总体而言，70%的妇女在4个月或更早开始首次产前护理。在从未上学的参与者中，略多于一半（52%）在4个月或更早接受首次产前护理，而接受过高等教育的大多数参与者（97%）在推荐时间接受首次产前护理。同样，最富裕五分之一人群中有89%，最贫困五分之一人群中有48%在推荐时间接受首次产前护理。在调整分析中，与最贫困的妇女相比，最富裕财富五分之一人群中的妇女更早开始产前护理的可能性显著更高（调整后比值比：3.74，95%置信区间：2.31 - 6.05）。同样，与从未上学的妇女相比，受教育程度较高的妇女更早开始产前护理的可能性显著更高（调整后比值比：11.40，95%置信区间：5.05 - 25.73）。与婆罗门/切特里种姓妇女相比，马德西其他种姓妇女早期接受产前护理的几率显著更低（调整后比值比：0.56，95%置信区间：0.35 - 0.90）。与想要怀孕的妇女相比，意外怀孕的妇女在4个月或更早接受首次产前护理的可能性显著更低（调整后比值比：0.73，95%置信区间：0.58 - 0.93）。
在不同教育、经济水平以及种姓/族群的妇女中，产前护理开始推荐时间的差异明显。农村妇女按照指南进行检查的可能性较小。研究结果表明需要采取干预措施来提高女性教育水平并改善家庭经济状况。适合当地背景和文化的针对性干预同样重要。增加计划生育方法的可及性并减少意外怀孕能够促进早期产前护理的接受。
