D Joshi1, S C Baral1, S Giri1, A M V Kumar2. 1. Health Research and Social Development Forum (HERD), Kathmandu, Nepal. 2. International Union Against Tuberculosis and Lung Disease South-East Asia Regional Office, New Delhi, India.
Abstract
Setting: Eight village development committees of Mugu District, a remote mountainous district of Nepal that has poor maternal health indicators. Objectives: 1) To assess the proportion of mothers who delivered in health facilities (institutional delivery); 2) among mothers who delivered at home, to understand their reasons for doing so; and 3) among mothers who delivered in health facilities, to understand their challenges. Design: Cross-sectional study involving semi-structured interviews with mothers conducted in 2015. Results: Of 275 mothers, 97 (35%) had an institutional delivery. Multivariate logistic regression analysis showed that women who resided within 1 h distance from the birthing centre, had adequate mass media exposure or had only one child were more likely to deliver in hospital. Reasons for non-institutional delivery (n = 178) were related to geographical access (49%), personal preferences (18%) and perceived poor quality care (4%). Mothers who accessed institutional delivery (n = 97) also reported difficulties related to travel (60%), costs (28%), dysfunctional health system (18%) and unfriendly attitudes of the health-care providers (7%). Conclusion: To improve access to institutional delivery, the government should establish a 24/7 emergency ambulance network, including air ambulance. Health system issues, including unfriendly staff attitudes, urgently need to be addressed to gain the trust of the mothers.
Setting: Eight village development committees of Mugu District, a remote mountainous district of Nepal that has poor maternal health indicators. Objectives: 1) To assess the proportion of mothers who delivered in health facilities (institutional delivery); 2) among mothers who delivered at home, to understand their reasons for doing so; and 3) among mothers who delivered in health facilities, to understand their challenges. Design: Cross-sectional study involving semi-structured interviews with mothers conducted in 2015. Results: Of 275 mothers, 97 (35%) had an institutional delivery. Multivariate logistic regression analysis showed that women who resided within 1 h distance from the birthing centre, had adequate mass media exposure or had only one child were more likely to deliver in hospital. Reasons for non-institutional delivery (n = 178) were related to geographical access (49%), personal preferences (18%) and perceived poor quality care (4%). Mothers who accessed institutional delivery (n = 97) also reported difficulties related to travel (60%), costs (28%), dysfunctional health system (18%) and unfriendly attitudes of the health-care providers (7%). Conclusion: To improve access to institutional delivery, the government should establish a 24/7 emergency ambulance network, including air ambulance. Health system issues, including unfriendly staff attitudes, urgently need to be addressed to gain the trust of the mothers.
Authors: Erik von Elm; Douglas G Altman; Matthias Egger; Stuart J Pocock; Peter C Gøtzsche; Jan P Vandenbroucke Journal: Int J Surg Date: 2014-07-18 Impact factor: 6.071
Authors: K Tayler-Smith; R Zachariah; M Manzi; W Van den Boogaard; G Nyandwi; T Reid; E De Plecker; V Lambert; M Nicolai; S Goetghebuer; B Christiaens; B Ndelema; A Kabangu; J Manirampa; A D Harries Journal: Trop Med Int Health Date: 2013-05-18 Impact factor: 2.622