School of Public Health and Community Medicine, B.P Koirala Institute of Health Sciences, Dharan, Nepal.
Golden Community, Lalitpur, Nepal.
Matern Child Health J. 2020 Feb;24(Suppl 1):22-30. doi: 10.1007/s10995-019-02828-y.
The third Sustainable Development Goal, focused on health, includes two targets related to the reduction in maternal, newborn and under-five childhood mortality. We found it imperative to examine the equity and coverage of reproductive, maternal, newborn and child health (RMNCH) interventions from 2001 to 2016 in Nepal; and the death aversion that will take place during the SDG period.
We used the datasets from the Nepal Demographic Health Surveys (NDHS) 2001, 2006, 2011 and 2016. We calculated the coverage and equity for RMNCH interventions and the composite coverage index (CCI). Based on the Annualized Rate of Change (ARC) in the coverage for selected RMNCH indicators, we projected the trend for the RMNCH interventions by 2030. We used the Lives Saved Tools (LiST) tool to estimate the maternal, newborn, under-five childhood deaths and stillbirths averted. We categorised the interventions into four different patterns based on coverage and inequity gap.
Between 2001 and 2016, a significant improvement is seen in the overall RMNCH intervention coverage-CCI increasing from 46 to 75%. The ARC was highest for skilled attendance at birth (11.7%) followed by care seeking for pneumonia (8.2%) between the same period. In 2016, the highest inequity existed for utilization of the skilled birth attendance services (51%), followed by antenatal care (18%). The inequity gap for basic immunization services reduced significantly from 27.4% in 2001 to 5% in 2016. If the current ARC continues, then an additional 3783 maternal deaths, 36,443 neonatal deaths, 66,883 under-five childhood deaths and 24,024 stillbirths is expected to be averted by the year 2030.
Nepal has experienced an improvement in the coverage and equity in RMNCH interventions. Reducing inequities will improve coverage for skilled birth attendants and antenatal care. The current annual rate of change in RMNCH coverage will further reduce the maternal, neonatal, under-five childhood deaths and stillbirths.
第三个可持续发展目标关注健康，其中包括与降低孕产妇、新生儿和 5 岁以下儿童死亡率相关的两个具体目标。我们认为，有必要审视 2001 年至 2016 年期间尼泊尔生殖、孕产妇、新生儿和儿童健康（RMNCH）干预措施的公平性和覆盖范围，以及在可持续发展目标期间可能避免的死亡。
我们使用了尼泊尔人口与健康调查（NDHS）2001、2006、2011 和 2016 年的数据。我们计算了 RMNCH 干预措施的覆盖范围和公平性，并计算了综合覆盖指数（CCI）。根据选定的 RMNCH 指标的覆盖率年化变化率（ARC），我们预测了 2030 年 RMNCH 干预措施的趋势。我们使用 Lives Saved Tools（LiST）工具估计了避免的孕产妇、新生儿、5 岁以下儿童死亡和死产人数。我们根据覆盖范围和不平等差距将干预措施分为四种不同模式。
2001 年至 2016 年间，RMNCH 干预措施的整体覆盖范围-CCI 显著提高，从 46%增加到 75%。同期熟练接生和肺炎护理的利用率增长最快（分别为 11.7%和 8.2%）。2016 年，熟练接生服务利用率（51%）最高，其次是产前护理（18%）。基本免疫服务的不平等差距从 2001 年的 27.4%显著缩小到 2016 年的 5%。如果目前的 ARC 继续下去，那么到 2030 年，预计将避免 3783 例孕产妇死亡、36443 例新生儿死亡、66883 例 5 岁以下儿童死亡和 24024 例死产。
尼泊尔在 RMNCH 干预措施的覆盖范围和公平性方面取得了进展。减少不平等将提高熟练接生员和产前护理的覆盖率。目前 RMNCH 覆盖范围的年变化率将进一步降低孕产妇、新生儿、5 岁以下儿童死亡和死产人数。
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