High coverage but low quality of maternal and newborn health services in the coverage cascade: who is benefitted and left behind in accessing better quality health services in Nepal?

Khatri, Resham B.; Durham, Jo; Karkee, Rajendra; Assefa, Yibeltal

doi:10.1186/s12978-022-01465-z

Reproductive Health

Table 3 Social determinants of access to quality 4⁺ ANC visits in Nepal, 2016 (N = 1401)

From: High coverage but low quality of maternal and newborn health services in the coverage cascade: who is benefitted and left behind in accessing better quality health services in Nepal?

Determinants	Categories	Frequency (n = 1401)	%	p	4⁺ ANC visits Crude OR (95% CI)	4⁺ ANC visits Adjusted OR (95% CI)
Structural
Wealth rank	Lower	539	61.5	0.242	1.00
Wealth rank	Upper	862	65.6		1.19 (0.89,1.60)
Ethnicity	Disadvantaged	903	55.2	< 0.001	1.00	1.00
Ethnicity	Advantaged	498	80.1		3.26 (2.39, 4.45)***	1.68 (1.16, 2.43)**
Religion	Others	186	59.3	0.333	1.00
Religion	Hindu	1215	64.8		1. 26 (0.79–2.02)
Occupation	Not working	622	58.8	0.003	1.00
	Agriculture	596	65.7		1.35 (1.03,1.77)*
	Working paid	183	76.4		2.27 (1.38, 3.74)**
Maternal education	Illiterate	305	47.9	< 0.001	1.00
	Primary	249	58.7		1.55 (1.03, 2.34)*
	Secondary higher	847	71.4		2.72 (1.92, 3.86)***
Decision-making	Yes	486	70.7	0.003	1.00
Decision-making	No	915	60.5		0.63 (0.47, 0.85)**
Intermediary
Language	Nepali	673	76.2	< 0.001	1.00	1.00
	Maithili	244	31.7		0.14 (0.10, 0.22)***	0.42 (0.20, 0.88) *
	Bhojpuri	121	55.5		0.39 (0.23, 0.64)***	1.01 (0.48, 2.14)
	Others	363	65.9		0.60 (0.42, 0.87)**	0.82 (0.53, 1.25)
Residence	Urban	802	68.4	0.009	1.00
Residence	Rural	599	58.1		0.64 (0.46, 0.90)**
Province	One	266	59.7	< 0.001	1.00	1.00
	Two	298	36.9		0.39 (0.24, 0.65)***	0.74 (0.37,1.49)
	Bagmati	236	76.4		2.18 (1.31, 3.63)**	1.65 (0.97, 2.80)
	Gandaki	124	78.1		2.41 (1.36, 4.28)**	1.69 (1.02, 2.79)*
	Lumbini	272	71.9		1.72 (1.02, 2.92)*	1.47 (0.88, 2.46)
	Karnali	66	68.7		1.48 (0.86, 2.56)	1.37 (0.77, 2.43)
	Sudurpaschim	139	79.2		2.56 (1.57, 4.17)***	2.41 (1.46, 3.97)***
Region	Mountain	94	62.4	< 0.01	1.00
	Hill	579	74.8		0.56 (0.30, 1.06)
	Terai	728	55.7		0.42 (0.31, 0.58)***
Maternal age (years)	15–19	216	54.5	0.003	1.00
	20–34	1120	66.4		1.65 (1.24, 2.21)***
	35 +	66	54.9		1.02 (0.55, 1.88)
Birth order	< 4	1260	66.0	< 0.001	1.00	1.00
Birth order	≥ 4	142	46.6		0.45 (0.31, 0.65)***	0.54 (0.35, 0.85) **
Sex of child (index child)	Male	756	65.3	0.337	1.00
Sex of child (index child)	Female	645	62.5		0.89 (0.69, 1.13)
Access to bank account	No	904	57.1	< 0.001	1.00	1.00
Access to bank account	Yes	498	76.6		2.47 (1.83, 3.32)***	1.48 (1.08, 2.03) *
Media exposure	Yes	855	69.4	< 0.001	1.00
Media exposure	No	546	55.6		0.55 (0.42, 0.73)***
Last birth (index child)	Wanted	1149	64.9	0.229	1.00
Last birth (index child)	Unwanted	252	60.1		0.81 (0.58, 1.14)
Distance to health facilities as a perceived problem	No problem	588	71.6	< 0.001	1.00
Distance to health facilities as a perceived problem	Problem	814	58.6		0.56 (0.42, 0.75)***
Health system
Perceived problem not having female providers	No problem	438	79.6	< 0.001
Perceived problem not having female providers	Problem	963	57.0		0.34 (0.24, 0.48)***
Awareness of health mothers' group in the community	Yes	497	71.6	< 0.001	1.00
Awareness of health mothers' group in the community	No	904	59.9		0.59 (0.44, 0.80)***
C-section delivery	Yes	497	71.6	0.023	1.00
C-section delivery	No	1235	62.8		0.62 (0.41, 0.94)*

Significance at ***p < 0.001, **p < 0.01, *p < 0.05. Hosmer Lemeshow test for the model fitness (p = 0.575)

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