Khatri Resham Bahadur, Karkee Rajendra
a PhD Candidate, School of Public Health, Faculty of Medicine , The University of Queensland , Brisbane, Australia; Centers for Research and Development, Kathmandu , Nepal.
b Associate Professor, School of Public Health and Community Medicine , BP Koirala Institute of Health Sciences , Dharan , Nepal.
Reprod Health Matters. 2018 Nov;26(54):32-46. doi: 10.1080/09688080.2018.1535686. Epub 2018 Nov 7.
Nepal has one of the highest maternal and neonatal mortality rates among low- and middle-income countries. Nepal's health system focuses on life-saving interventions provided during the antenatal to postpartum period. However, the inequality in the uptake of maternity services is of major concern. This study aimed to synthesise evidence from the literature regarding the social determinants of health on the use of maternity services in Nepal. We conducted a structured narrative review of studies published from 1994 to 2016. We searched five databases: PubMed; CINAHL; EMBASE; ProQuest and Global Index Medicus using search terms covering four domains: access and use; equity determinants; routine maternity services and Nepal. The findings of the studies were summarised using the World Health Organization's Social Determinants of Health framework. A total of 59 studies were reviewed. A range of socio-structural and intermediary-level determinants was identified, either as facilitating factors, or as barriers, to the uptake of maternity services. These determinants were higher socioeconomic status; education; privileged ethnicities such as Brahmins/Chhetris, people following the Hindu religion; accessible geography; access to transportation; family support; women's autonomy and empowerment; and a birth preparedness plan. Findings indicate the need for health and non-health sector interventions, including education linked to job opportunities; mainstreaming of marginalised communities in economic activities and provision of skilled providers, equipment and medicines. Interventions to improve maternal health should be viewed using a broad 'social determinants of health' framework.
在低收入和中等收入国家中，尼泊尔的孕产妇和新生儿死亡率位居前列。尼泊尔的卫生系统侧重于提供产前至产后期间的救生干预措施。然而，孕产妇服务利用方面的不平等是一个主要问题。本研究旨在综合文献中关于尼泊尔孕产妇服务利用的健康社会决定因素的证据。我们对1994年至2016年发表的研究进行了结构化叙述性综述。我们使用涵盖四个领域的检索词搜索了五个数据库：PubMed、CINAHL、EMBASE、ProQuest和全球医学索引，这四个领域分别是：获取与利用；公平决定因素；常规孕产妇服务和尼泊尔。研究结果使用世界卫生组织的健康社会决定因素框架进行了总结。总共审查了59项研究。确定了一系列社会结构和中间层面的决定因素，这些因素要么是促进孕产妇服务利用的因素，要么是阻碍因素。这些决定因素包括较高的社会经济地位、教育、婆罗门/切特里等特权族裔、信奉印度教的人群、便利的地理位置、交通便利、家庭支持、妇女的自主权和赋权以及分娩准备计划。研究结果表明，需要卫生部门和非卫生部门进行干预，包括与就业机会相关的教育；将边缘化社区纳入经济活动的主流，并提供技术熟练的提供者、设备和药品。应使用广泛的“健康社会决定因素”框架来审视改善孕产妇健康的干预措施。
