Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Helen Keller International, Kathmandu, Nepal.
Matern Child Health J. 2020 Sep;24(9):1121-1129. doi: 10.1007/s10995-020-02961-z.
Maternal health-seeking behaviors are critical to improving maternal and child health in low-income countries. This study investigates associations between maternal decision-making input and their health-seeking behaviors in the first 1000-day period between pregnancy and a child's second birthday in Nepal.
We used data from a cross-sectional survey conducted in 2018 in 16 districts of Nepal. Among the 3648 households surveyed, 1910 mothers of a child 0 to 24 months with complete data were included for analyses. Logistic regression was used to examine associations between decision-making input and the utilization of antenatal, delivery and postnatal care services, and attendance at health mothers' group (HMG) meetings. We also used negative binomial regression to assess the relationship between her decision-making input and participation in growth monitoring and promotion (GMP) in the 6 months prior to the survey. For each relationship examined, we adjusted for clustering, as well as potentially confounding factors at individual and household levels.
After adjusting for confounders, maternal decision-making input had a small but positive and significant association with receiving at least 4 antenatal care visits (OR = 1.09, 95% CI 1.02, 1.17), attendance at GMP in the 6 months prior to the survey (IRR = 1.02, 95% CI 1.00, 1.04), and HMG attendance (OR = 1.10, 95% CI 1.03, 1.17), but not with receiving at least 3 postnatal care visits or delivering in a health institution.
Our findings indicated that empowering women and mothers in household decision-making might warrant greater attention when developing future policies and programs in Nepal.
孕产妇寻求医疗保健的行为对于改善低收入国家母婴健康至关重要。本研究调查了尼泊尔孕产妇在妊娠和儿童 2 岁生日期间的前 1000 天内，其决策参与情况与寻求医疗保健行为之间的关联。
我们使用了 2018 年在尼泊尔 16 个地区进行的一项横断面调查的数据。在调查的 3648 户家庭中，纳入了 1910 名 0 至 24 个月儿童的母亲进行分析，这些母亲的孩子数据完整。使用逻辑回归来检验决策参与与产前、分娩和产后护理服务的利用以及参加健康母亲小组（HMG）会议之间的关联。我们还使用负二项回归来评估她的决策参与与调查前 6 个月内参与生长监测和促进（GMP）之间的关系。对于每种关系，我们都进行了调整，以控制个体和家庭层面的聚类以及潜在的混杂因素。
在调整了混杂因素后，孕产妇决策参与与接受至少 4 次产前护理就诊（OR=1.09，95%CI 1.02，1.17）、调查前 6 个月内参加 GMP（IRR=1.02，95%CI 1.00，1.04）和 HMG 出勤率（OR=1.10，95%CI 1.03，1.17）之间存在微弱但显著的正相关关系，但与接受至少 3 次产后护理就诊或在医疗机构分娩无关。
我们的研究结果表明，在尼泊尔制定未来的政策和方案时，赋予家庭决策中的妇女和母亲权力可能需要得到更多关注。
