Assessment of antenatal and obstetric care services in a rural district of Nepal:
Saved in:
| Main Author: | |
|---|---|
| Format: | Book |
| Language: | German |
| Published: |
Frankfurt am Main [u.a.]
Lang
1999
|
| Series: | Medizin in Entwicklungsländern
45 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Item Description: | Zugl.: Heidelberg, Univ., Diss., 1997 |
| Physical Description: | XXI, 156 S. graph. Darst., Kt. |
| ISBN: | 3631347189 082044328X |
Staff View
MARC
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| 245 | 1 | 0 | |a Assessment of antenatal and obstetric care services in a rural district of Nepal |c Maureen Dar Iang |
| 264 | 1 | |a Frankfurt am Main [u.a.] |b Lang |c 1999 | |
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| 650 | 4 | |a Prenatal Care |z Nepal | |
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Record in the Search Index
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| adam_text | Table of contents v
Table of Contents
List of tables xii
List of figures xiii
List of abbreviations xiv
Forward by Prof. H. J. Diesfeld xv
Acknowledgements xvii
Executive summary xix
11 Introduction 1 3 |
1.1 The purpose of the study 2
1.1.1 The study questions 2
1.1.2 The study objectives 3
12 Literature review 5 28 1
2.1 Introduction 5
2.2 Nepal: the country background 5
2.2.1 Geography and demography 5
2.2.2 Politics, economy and society 6
2.2.3 The health care system 6
2.2.4 Nepal s safe motherhood policy and programme .. 7
The national antenatal risk catalogue 8
2.3 The global safe motherhood programme 9
2.3.1 The concept and goal of the global safe motherhood
initiative 9
2.3.2 The history of safe motherhood programmes 10
2.3.3 The criticisms on safe motherhood programmes .... 11
2.3.3.1 Antenatal care 11
2.3.3.2 Obstetric care 12
2.3.3.3 Post natal care and family planning 14
2.4 Assessing antenatal and obstetric care services 14
2.4.1 Definition of quality and methodological issues in
quality assessment 15
vi Table of contents
2.4.2 Assessment of quality of antenatal and obstetric care
service 17
2.4.2.1 Availability 18
2.4.2.2 Accessibility 18
Geographical accessibility 19
Financial accessibility 20
Socio cultural accessibility 20
2.4.2.3 Coverage (utilisation) 21
2.4.2.4 Performance of health services (service
quality) 22
2.4.2.5 Users satisfaction 24
2.4.3 Assessment of community perspectives on care during
pregnancy and childbirth 25
2.4.3.1 Beliefs and practices of community regarding
pregnancy and childbirth 25
2.4.3.2 Risk perception and perception of illness
aetiology by community regarding pregnancy 26
and childbirth 2.4.3.3 Value and status of women in the society ... 27
2.4.3.4 Perspectives of community on modern health
services 28
2.5 Summary of literature on assessing safe motherhood
programmes 28
13 Material and Methods 29 42
3.1 Introduction 29
3.2 Short description of the study area 29
3.3 Study design 29
3.3.1 Study methods and data sources 29
3.3.2 Study targets and selection of health facilities 30
3.4 Data collection 31
3.4.1 Selection and training of interviewers 32
3.4.2 Pilottesting 33
3.4.3 Data collection instruments 33
3.4.4 Quantitative data collection 34
Table of contents vii^
3.4.4.1 Document reviews 34
3.4.4.2 Inventories of building, equipment, drugs and
consumable 36
3.4.4.3 Observation of health worker s performance 36
3.4.4.4 Interviews with health workers 37
3.4.4.5 Interviews with health service users 38
Antenatal exit interviews 38
Maternity interviews 38
3.4.5 Qualitative data collection 39
3.4.5.1 Focus group discussions 39
3.4.5.2 Key informant interviews 40
3.5 Feedback to the community 41
3.6 Data recording and analysis 41
3.7 Limitations 42
14 Results 43 84
4.1 The state of maternal health care infrastructure in Banke
district, Nepal 43
4.1.1 Availability of antenatal and obstetric care services in
thedistrict 43
4.1.1.1 Service outlets 43
4.1.1.2 Health manpower 44
Professional health workers 44
Trained traditional birth attendants 44
4.1.2 Availability of antenatal and obstetric care services in
the selected facilities 45
4.1.2.1 Health service outlets 45
4.1.2.2 Health manpower 46
4.1.2.3 Availability of essential equipment, drugs and
consumable in the selected 14 FLHS 46
4.1.2.4 Availability of equipment, drugs and
consumable in the referral hospital 46
4.1.3 Accessibility of antenatal and obstetric care services 48
4.1.3.1 Geographical accessibility 48
Geographical accessibility of selected 14 FLHS 48
viii Table of contents
Geographical accessibility of referral level
obstetric care 49
4.1.3.2 Financial accessibility 50
Financial accessibility of antenatal care services 50
Financial accessibility of hospital delivery care
services 51
4.1.3.3 Socio cultural accessibility 51
4.2 The state of maternal health care delivery in Banke district 51
4.2.1 Coverage of maternal health care 52
4.2.1.1 Antenatal care 52
Antenatal coverage by FLHS and by distance 52
Coverage by age and parity 52
Coverage by religion 52
Intensity of use 52
Timeliness of care 53
4.2.1.2 Delivery care 54
Obstetric coverage by place of origin 55
Obstetric coverage by age and parity 55
4.2.1.3 Post natal care 56
4.2.2 Health service performances 56
4.2.2.1 Knowledge of health workers excluding TB A 57
4.2.2.2 Performance of health workers on preventive
and promotive activities of ANC 58
Consultation and counselling time 58
Health education and counselling 58
Effectiveness of health education and
counselling 59
Anaemia prophylactics 59
Tetanus prophylactics 60
4.2.2.3 Health worker s performance on screening
activities 61
Health worker s perception of high risk
pregnancies 61
History taking and examination 62
Identification and correct interpretation of high
risk pregnancies 62
Sensitivity of the screening process 64
Table of contents ix_
4.2.2.4 Intervention according to risk factors and health
problems identified: referral to referral level
hospital 64
Reasons for referral advice 64
Population based referral advice rate of high
risk pregnancies 64
Referral compliance 65
4.2.2.5 Management at referral level obstetric care ... 66
Care at admission, delivery and discharge ... 67
Timeliness of care 68
Output related to obstetric care at referral level 68
Coverage of high risk pregnancies at referral
level 68
4.2.3 Outcome of maternal health care in referral level 70
4.2.3.1 Stillbirth rate 70
4.2.3.2 Maternal mortality ratio 71
4.2.4 Co ordination and supervision among health workers 71
4.2.5 In service training of health workers 71
4.3.6 Community involvement in health care delivery 71
4.3 Determinants of maternal health care services utilisation ... 72
4.3.1 Quality of service according to service users 72
Waiting time 72
Reasons for choosing this centre 73
Reasons for coming to ANC 73
Reasons for intended hospital or home delivery 73
Claimed benefits from antenatal care 74
Patient satisfaction 75
Suggestions 75
4.3.2 Beliefs and practices of community regarding
pregnancy and childbirth 75
Nutrition 75
Clean delivery 76
Hard working and rest 76
Sexual behaviour 77
Medical intervention 77
4.3.3 Risk perception by community regarding pregnancy
and childbirth 77
x Table of contents
4.3.4 Choice of healers according to beliefs on illness
aetiology 77
Vomiting and loss of appetite in pregnancy ... 78
STD related symptoms 78
Retained placenta 79
Prolonged labour 79
High fever 80
4.3.5 Determinants of use of modern health service in 80
pregnancy and childbirth 4.3.5.1 The influence of cultural tradition on use of
services 80
Pregnancy and delivery seen as a natural
process 80
Childbirth as a family event 81
Shyness and fear 81
Social status of health workers 81
4.3.5.2 The influence of health service factors 82
Relatively new services 82
Performance of health workers 82
Hospital regulations which do not consider
cultural value 82
Expensive hospital fees vs. Free service by
local healers 82
Organisational and geographical accessibility 83
4.3.5.3 The influence of to socio economic conditions
on use of service 83
Lack of education 83
Distribution of property and power 84
15 Discussion, conclusion and recommendations 85 106 |
5.1 Infrastructure and organisation of maternal health care 85
services 5.2 Utilisation of antenatal and obstetric care services in Banke
district 86
5.3 Why is the utilisation of maternity care services
comparatively low in Banke district? 88
5.3.1 Health service factors influencing utilisation 89
Table of contents xi
5.3.2 Does socio cultural tradition play an important role in
utilisation of modern maternity care services in Banke
district? 92
5.4 Do preventive and promotive activities in antenatal care
benefit antenatal attendees? 95
Health education and counselling 95
Prevention and treatment of anaemia 96
Prevention of tetanus 96
5.5 Does risk approach in antenatal care work in this district? ... 97
The process of screening, identification of risk
pregnancy, and referral advice 97
Management at referral level 100
5.6 Conclusion 101
Socio cultural factors play an important role in health
services utilisation in this community 102
Conventional deficiency of health service is impeding
utilisation of health care services 102
Low effectiveness of services for users 103
5.7 Recommendations 104
Bibliography 107 119
List of annexes and maps 121 156
xii Table of contents
List of Tables
Table Title Page
Table 1 Sampling frame with selected facilities and their
catchment population 29
Table 2 Availability of health manpower, Banke district 45
Table 3 Availability of essential drugs and consumable at
selected 14 FLHS 47
Table 4 Individual achievement of selected FLHS on drugs
and supplies and on equipment for antenatal and 48
delivery care
Table 5 Availability of essential equipment, drugs and
consumable at labour room and theatre, government 48
hospital
Table 6 Geographical accessibility of selected 14 FLHS 49
Table 7 Distance vs. means of transport used by antenatal
attendees 49
Table 8 Accessibility of referral level hospital, Banke district 50
Table 9 Coverage of antenatal care by individual FLHS 53
Table 10 Antenatal coverage by age of women in selected 14
FLHS 53
Table 11 Antenatal coverage by number of gestation in selected
14 FLHS 54
Table 12 Weeks of gestation at 1st antenatal visit from AN card
review 54
Table 13 Coverage of delivery by health care providers, Banke
district 55
Table 14 Coverage of hospital delivery and population based
CS rate by distance, Banke district 55
Table 15 Coverage of hospital delivery by age 56
Table 16 Coverage of hospital delivery by number of gestations 56
Table 17 Contents of health education given to antenatal
attendees 59
Table 18 Health worker s perception of high risk pregnancies 61
Table 19 Essential contents of history taking, physical
examination and laboratory tests done during 63
antenatal care
Table 20 Reasons given for referral advice according to
antenatal attendees and recorded in antenatal cards 65
Table of contents xm
Table 21 Availability of essential obstetric care at government
hospital 67
Table 22 Profile of CS by indication, government private
hospitals 69
Table 23 Frequency of risk factors among hospital deliveries
and pregnant women in the population, government 69
hospital
Table 24 Stillbirth rate by mode of delivery, government 70
hospital
Table 25 Still birth rate vs. place of origin mode of delivery
among hospital deliveries, government hospital 70
Table 26 Stillbirth rate by birth weight among vaginal delivery,
government hospital 71
Table 27 Reasons given for choosing this centre for antenatal
care 73
Table 28 Reasons given for intending hospital delivery by
antenatal attendees 74
Table 29 Reasons given for intending home delivery by
antenatal attendees 74
Table 30 Suggestions given to improve services by antenatal
attendees 75
List of figures
Figure Title Page
Figure 1 Knowledge of FLHS staff on antenatal and obstetric
care 57
Figure 2 Proportion of antenatal attendees counselled 58
Figure 3 Population based coverage of anaemia prophylactics in
pregnancy 60
Figure 4 Effectiveness of screening in pregnancy, Banke district 66
|
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| geographic | Banke (DE-588)4551288-7 gnd |
| geographic_facet | Banke |
| id | DE-604.BV012482000 |
| illustrated | Illustrated |
| indexdate | 2024-07-09T18:28:22Z |
| institution | BVB |
| isbn | 3631347189 082044328X |
| language | German |
| oai_aleph_id | oai:aleph.bib-bvb.de:BVB01-008472745 |
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| physical | XXI, 156 S. graph. Darst., Kt. |
| publishDate | 1999 |
| publishDateSearch | 1999 |
| publishDateSort | 1999 |
| publisher | Lang |
| record_format | marc |
| series | Medizin in Entwicklungsländern |
| series2 | Medizin in Entwicklungsländern |
| spelling | Dar Iang, Maureen 1963- Verfasser (DE-588)121180697 aut Assessment of antenatal and obstetric care services in a rural district of Nepal Maureen Dar Iang Frankfurt am Main [u.a.] Lang 1999 XXI, 156 S. graph. Darst., Kt. txt rdacontent n rdamedia nc rdacarrier Medizin in Entwicklungsländern 45 Zugl.: Heidelberg, Univ., Diss., 1997 Maternal Health Services Nepal Maternal health services Nepal Maternal-Child Health Centers Nepal Prenatal Care Nepal Prenatal care Nepal Rural Health Services Nepal Rural health services Nepal Geburtshilfe (DE-588)4019604-5 gnd rswk-swf Schwangerschaft (DE-588)4053724-9 gnd rswk-swf Primäre Gesundheitsversorgung (DE-588)4196757-4 gnd rswk-swf Banke (DE-588)4551288-7 gnd rswk-swf (DE-588)4113937-9 Hochschulschrift gnd-content Banke (DE-588)4551288-7 g Schwangerschaft (DE-588)4053724-9 s Primäre Gesundheitsversorgung (DE-588)4196757-4 s DE-604 Geburtshilfe (DE-588)4019604-5 s Medizin in Entwicklungsländern 45 (DE-604)BV000000925 45 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008472745&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Dar Iang, Maureen 1963- Assessment of antenatal and obstetric care services in a rural district of Nepal Medizin in Entwicklungsländern Maternal Health Services Nepal Maternal health services Nepal Maternal-Child Health Centers Nepal Prenatal Care Nepal Prenatal care Nepal Rural Health Services Nepal Rural health services Nepal Geburtshilfe (DE-588)4019604-5 gnd Schwangerschaft (DE-588)4053724-9 gnd Primäre Gesundheitsversorgung (DE-588)4196757-4 gnd |
| subject_GND | (DE-588)4019604-5 (DE-588)4053724-9 (DE-588)4196757-4 (DE-588)4551288-7 (DE-588)4113937-9 |
| title | Assessment of antenatal and obstetric care services in a rural district of Nepal |
| title_auth | Assessment of antenatal and obstetric care services in a rural district of Nepal |
| title_exact_search | Assessment of antenatal and obstetric care services in a rural district of Nepal |
| title_full | Assessment of antenatal and obstetric care services in a rural district of Nepal Maureen Dar Iang |
| title_fullStr | Assessment of antenatal and obstetric care services in a rural district of Nepal Maureen Dar Iang |
| title_full_unstemmed | Assessment of antenatal and obstetric care services in a rural district of Nepal Maureen Dar Iang |
| title_short | Assessment of antenatal and obstetric care services in a rural district of Nepal |
| title_sort | assessment of antenatal and obstetric care services in a rural district of nepal |
| topic | Maternal Health Services Nepal Maternal health services Nepal Maternal-Child Health Centers Nepal Prenatal Care Nepal Prenatal care Nepal Rural Health Services Nepal Rural health services Nepal Geburtshilfe (DE-588)4019604-5 gnd Schwangerschaft (DE-588)4053724-9 gnd Primäre Gesundheitsversorgung (DE-588)4196757-4 gnd |
| topic_facet | Maternal Health Services Nepal Maternal health services Nepal Maternal-Child Health Centers Nepal Prenatal Care Nepal Prenatal care Nepal Rural Health Services Nepal Rural health services Nepal Geburtshilfe Schwangerschaft Primäre Gesundheitsversorgung Banke Hochschulschrift |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008472745&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
| volume_link | (DE-604)BV000000925 |
| work_keys_str_mv | AT dariangmaureen assessmentofantenatalandobstetriccareservicesinaruraldistrictofnepal |