Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
Nepal Public Health Foundation, Kathmandu, Nepal.
BMC Pregnancy Childbirth. 2019 Aug 27;19(1):310. doi: 10.1186/s12884-019-2465-6.
Globally in 2017 neonatal death accounted for 46% of under-five deaths. Nepal is among the developing countries which has a high number of neonatal deaths. The rates are high among poor socio-economic groups, marginalized, as well as people living in remote areas of Nepal. This paper, thus tries to examine the utilization pattern and maternal, household, and health service factors affecting underprivileged ethnic groups in Midwest Nepal.
A cross-sectional mixed method study was conducted from September 2017 to April 2018 in Bardiya district. Quantitative data were collected from a household survey of women who gave live births within the last 12 months prior to data collection (n = 362). Interviews were also undertaken with 10 purposively selected key informants. Logistic regression model was used to determine the factors associated with essential neonatal care utilization. Thematic analysis was undertaken on the qualitative data.
Overall, neonatal care utilization was 58.6% (53.3-63.7%), with big variations seen in the coverage of selected neonatal care components. Factors such as birth order (2.059, 1.13-3.75), ethnicity (2.28, 1.33-3.91), religion (2.37, 1.03-5.46), perceived quality of maternal and neonatal services (2.66, 1.61-4.39) and awareness on immediate essential newborn cares (2.22, 1.28-3.87) were identified as the determining factors of neonatal care utilization.
The coverage of birth preparedness and complication readiness, adequate breastfeeding, and postnatal care attendance were very low as compared to the national target for each component. The determinants of essential neonatal care existed at maternal, household as well as health facility level and included ethnicity, religion, perceived quality of maternal and neonatal services, birth order and awareness on immediate essential newborn care. Appropriate birth spacing, improving the quality of maternal and neonatal services at health facilities and raising mother's level of awareness about neonatal care practices are recommended.
2017 年全球新生儿死亡占五岁以下儿童死亡人数的 46%。尼泊尔是新生儿死亡人数较多的发展中国家之一。在尼泊尔贫穷的社会经济群体、边缘化群体以及生活在偏远地区的人群中，新生儿死亡率较高。本文试图研究尼泊尔中西部贫困少数民族群体的利用模式以及母婴、家庭和卫生服务因素。
2017 年 9 月至 2018 年 4 月，在巴迪亚区进行了一项横断面混合方法研究。对在数据收集前 12 个月内生育活产儿的妇女进行了家庭调查，收集了定量数据（n=362）。还对 10 名有针对性选择的关键信息员进行了访谈。采用逻辑回归模型确定与基本新生儿护理利用相关的因素。对定性数据进行了主题分析。
总体而言，新生儿护理利用率为 58.6%（53.3-63.7%），但在选定新生儿护理组成部分的覆盖范围方面存在很大差异。出生顺序（2.059，1.13-3.75）、民族（2.28，1.33-3.91）、宗教（2.37，1.03-5.46）、母婴服务质量感知（2.66，1.61-4.39）和对新生儿基本急救意识（2.22，1.28-3.87）等因素被确定为新生儿护理利用的决定因素。
与每个组成部分的国家目标相比，出生准备和并发症准备、充足的母乳喂养和产后护理的覆盖率非常低。基本新生儿护理的决定因素存在于母婴、家庭以及医疗机构层面，包括民族、宗教、母婴服务质量感知、出生顺序和对新生儿基本急救意识。建议适当的生育间隔、提高医疗机构的母婴服务质量以及提高母亲对新生儿护理实践的认识。
