Barriers to Utilization of Antenatal Care Services in Eastern Nepal.
Barriers to Utilization of Antenatal Care Services in Eastern Nepal.
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DOI：
10.3389/fpubh.2015.00197
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发表时间：
2015
影响因子：
5.2
通讯作者：
Wagle RR
中科院分区：
文献类型：
--
作者：
Deo KK;Paudel YR;Khatri RB;Bhaskar RK;Paudel R;Mehata S;Wagle RR
世界卫生组织建议正常妊娠至少进行四次妊娠检查。尼泊尔卫生和人口部出台了各种战略来促进产前护理和机构分娩，以减少孕产妇和儿童死亡。然而，在某些特定的社会经济群体和种族群体中，孕产妇保健服务利用率较低。因此，本研究旨在评估尼泊尔东部建议的四次产前护理 (4ANC) 就诊的障碍。在 Sunsari 地区进行了一项横断面定量研究。使用半结构化问卷对调查前一年内分娩的 372 名随机抽取的女性进行了采访。进行双变量和多变量逻辑回归分析以确定与 4ANC 就诊相关的障碍。超过三分之二的女性 (69%) 至少参加过 4 次 ANC 就诊。研究显示，与不接触媒体的女性相比，接触媒体的女性接受四次或更多 ANC 就诊的机会更高，且调整后的比值比（aOR = 3.5，95% CI：1.2–10.1）。来自优势种族群体的女性比来自弱势种族群体的受访者有更多机会进行 4ANC 就诊（aOR = 2.4，95% CI：2.1–6.9）。同样，与自主程度较低且经济贫困的女性相比，自主程度较高的女性进行至少 4 次 ANC 就诊的可能性高出近三倍（aOR = 2.9，95% CI：1.5–5.6），较富有的女性进行至少 4 次 ANC 就诊的可能性高出两倍（aOR = 2.3，95% CI：1.1–5.3）。来自弱势种族、女性自主权较低、对孕产妇保健服务和完成 ANC 后的激励了解较少、与孕产妇保健服务相关的媒体曝光较少以及较低的财富等级与少于推荐的 4ANC 就诊次数显着相关。因此，孕产妇保健计划需要解决此类社会文化障碍，以有效利用卫生保健。
World Health Organization recommends at least four pregnancy check-ups for normal pregnancies. Ministry of Health and Population Nepal has introduced various strategies to promote prenatal care and institutional delivery to reduce maternal and child deaths. However, maternal health service utilization is low in some selected socio-economic and ethnic groups. Hence, this study aims to assess barriers to the recommended four antenatal care (4ANC) visits in eastern Nepal. A cross-sectional quantitative study was conducted in Sunsari district. A total of 372 randomly selected women who delivered in the last year preceding the survey were interviewed using a semi-structured questionnaire. Bivariate and multivariate logistic regression analysis was carried out to identify barriers associated with 4ANC visits. More than two-third women (69%) attended at least 4ANC visits. The study revealed that women exposed to media had higher chance of receiving four or more ANC visits with an adjusted odds ratio (aOR = 3.5, 95% CI: 1.2–10.1) in comparison to women who did not. Women from an advantaged ethnic group had more chance of having 4ANC visits than respondents from a disadvantaged ethnic group (aOR = 2.4, 95% CI: 2.1–6.9). Similarly, women having a higher level of autonomy were nearly three times more likely (aOR = 2.9, 95% CI: 1.5–5.6) and richer women were twice (aOR = 2.3, 95% CI: 1.1–5.3) as likely to have at least 4ANC visits compared to women who had a lower level of autonomy and were economically poor. Being from disadvantaged ethnicity, lower women’s autonomy, poor knowledge of maternal health service and incentive upon completion of ANC, less media exposure related to maternal health service, and lower wealth rank were significantly associated with fewer than the recommended 4ANC visits. Thus, maternal health programs need to address such socio-cultural barriers for effective health care utilization.