RESUMO
Background:Nepalese society is traditionally patriarchal and son-preferred with increasing numbers of sex-selective abortions. In this context, this study aims to assess the gender preference and associated factors among pregnant women visiting the antenatal care ward of a large public maternity hospital in Kathmandu, Nepal.Methods:A hospital-based cross-sectional study was carried out among 821 antenatal women. Data was collected via face to face interview with structured questionnaire, and gender preference was assessed using Coombs’ scale.Results:At the first instance, more than half 56.2% respondents wished to have two sons and one daughter if they were to have only three children. On asking further questions as per the Coombs’ scale, about 40% of the respondents had son preference falling in IS scale 7-5, 33% had balanced IS-4, and 27% had daughter preference (IS 3-1). The respondent characteristics significantly associated with gender preference were ecological region (p=0.007), education (p=0.009), marital duration (p=0.044) and parity 0.32.Conclusions:The wish to have son is prevalent among the respondents followed by a mixed gender of children. Educational status, ecological region, and parity explain this differential wish. Women’s education and autonomy are the areas to tackle with sex biasof offspring
RESUMO
Background: Considering the commitment and investment of Nepal to reduce maternal and child mortality, understanding service utilization and factors associated with a child and maternal health services is important. Objectives: This study was examined the factors associated with utilization of maternal and child health services in Kapilvastu District of Nepal. Materials and Methods: A cross-sectional study was conducted in 2010 by interviewing 190 mothers having children of aged 12-23 months using the standardized questionnaire. Results: Immunization status (97.4%) and vitamin A supplementation (98.4%) was high. However, initiation of breastfeeding within an hour of birth was low (45.3%) and 63.2% had practiced exclusive breastfeeding. Majority (69.5%) of respondents delivered their child at home and 39.5% sought assistance from health workers. The mothers who did not have any education, mothers from Dalit/Janjati and the Terai origin were less likely to deliver at the health facility and to seek the assistance of health workers during childbirth. Conclusion: The immunization program coverage was high, whereas maternal health service utilization remained poor. Interventions that focus on mothers from Dalit/Janjati group and with lower education are likely to increase utilization of maternal health services.
RESUMO
The structure and provision mechanism of maternity services in Nepal appears to be good, with adequate coverage and availability. Utilization of maternity services has also improved in the past decade. However, this progress may not be adequate to achieve the Millennium Development Goal to improve maternal health (MDG 5) in Nepal. This paper reviews the factors that impede women from utilizing maternity services and those that encourage such use. Twenty-one articles were examined in-depth with results presented under four headings: (i) sociocultural factors; (ii) perceived need/benefit of skilled attendance; (iii) physical accessibility; and (iv) economic accessibility. The majority of the studies on determinants of service use were cross-sectional focusing on sociocultural, economic and physical accessibility factors. In general, the education of couples, their economic status and antenatal check-ups appeared to have positive influences. On the other hand, traditional beliefs and customs, low status of women, long distance to facilities, low level of health awareness and women’s occupation tended to impact negatively on service uptake. More analytical studies are needed to assess the effectiveness of the Safer Mother Programme, expansion of rural birth centres and birth-preparedness packages on delivery-service use. Moreover, it is important to investigate women’s awareness of the need of facility delivery and their perception of the quality of health facilities in relation to actual usage.
RESUMO
Background: Choice of health‑care services depends on patients’ characteristics and the features of health‑care facilities available. In Nepal, a significant proportion of health care is provided through the private sector, despite the introduction of free essential health care for all citizens in 2008. We sought to determine whether people chose private or public facilities in the first instance for acute health problems. We also assessed the reasons for their choice. Materials and Methods: A cross‑sectional survey was done by use of a questionnaire administered to 400 household heads in Jhapa district, Nepal. Results: 272 (68%) respondents sought treatment from public health‑care facilities in the first instance. On adjusted analysis, illiterate people were more likely to choose public facilities than people with higher secondary education (OR 5.47, P = 0.002). Similarly, lower‑caste and religious‑minority respondents were more likely to choose public facilities than disadvantaged janajati (OR 2.33, P = 0.01). Among respondents who used public facilities, 174 (64.0%) and 109 (40.0%) stated that that their choice was based on financial accessibility and physical accessibility, respectively. Among respondents who used private facilities, 65 (50.7%) and 54 (42.1%) said their choice was based on adequacy of resources/services and health‑care delivery, respectively. Conclusion: A substantial portion of respondents used public health‑care facilities in the first instance, mainly because of financial and physical accessibility rather than adequacy of resources or better health‑care delivery. These results may indicate a positive impact of removal of user fees for public health‑care facilities in Nepal, especially for impoverished people.