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Table 4 Social determinants of access to quality institutional delivery in Nepal, 2016 (N = 1270)

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 = 1270) % p Institutional delivery
cOR (95% CI)
Institutional delivery
aOR (95% CI)
Structural
Wealth rank Lower 405 42.1 0.692 0.95 (0.72, 1.24)  
Upper 865 43.4   1.00  
Ethnicity Disadvantaged 819 41.0 0.078 0.79 (0.61, 1.03)  
Advantaged 451 46.6   1.00  
Religion Others 193 45.2 0.591 1.00  
Hindu 1,076 42.6   0.90 (0.62, 1.32)  
Occupation Not working 636 41.5 0.082 1.00 (0.76, 1.30)  
Agriculture 460 41.6   1.00  
Working paid 174 51.9   1.51 (1.00, 2.29)*  
Maternal education Illiterate 270 38.5 0.278 0.76 (0.51, 1.15)  
Primary 208 40.5   1.00  
Secondary higher 792 45.2   0.83 (0.58, 1.17)  
Decision-making Yes 439 49.3 0.013 1.00  
No 830 39.7   0.68 (0.50, 0.92)*  
Intermediary
Language Nepali 589 47.2 0.073 1.00  
Maithili 204 37.2   0.66 (0.43,1.02)  
Bhojpuri 141 36.5   0.64 (0.47, 0.89)**  
Others 336 41.9   0.81 (0.57, 1.14)  
Residence Urban 781 43.9 0.449 1.00  
Rural 489 41.6   0.91 (0.70, 1.19)  
Province One 223 41.0 0.037 1.00  
Two 280 36.8   0.84 (0.52, 1.35)  
Bagmati 226 50.6   1.47 (0.89, 2.45)  
Gandaki 121 50.4   1.47 (0.85, 2.53)  
Lumbini 239 46.0   1.23 (0.79, 1.91)  
Karnali 53 37.7   0.87 (0.49, 1.55)  
Sudurpaschim 128 36.2   0.82 (0.50, 1.33)  
Region Mountain 59 30.0 0.015 1.00  
Hill 514 47.1   0.48 (0.33, 0.71)***  
Terai 697 41.1   0.78 (0.60, 1.03)  
Maternal age (years) 15–19 206 41.2 0.322 1.00  
20–34 1007 43.9   1.12 (0.78, 1.61)  
35+ 57 32.3   0.68 (0.32, 1.43)  
Birth order < 4 1153 44.0 0.081 1.00  
≥ 4 117 33.4   0.64 (0.39, 1.06)  
Sex of child (index child) Male 698 44.3 0.330 1.00  
Female 572 41.3   0.88 (0.69, 1.13)  
Access to bank account No 798 40.9 0.120 0.80 (0.60, 1.06)  
Yes 472 46.5   1.00  
Media exposure Yes 807 44.4 0.184 1.00  
No 463 40.6   0.86 (0.68, 1.08)  
Last birth (index child) Wanted 1027 43.4 0.678 1.00  
Unwanted 243 41.3   0.92 (0.62, 1.36)  
Distance to health facilities as a perceived problem No problem 581 45.3 0.174 1.00  
Problem 689 41.0   0.84 (0.65, 1.08)  
Health system
Perceived problem not having female providers No problem 419 47.2 0.057 1.00  
problem 851 40.9   0.77 (0.59, 1.01)  
Awareness of health mothers’ group in the community Yes 426 44.2 0.562 1.00  
No 844 42.4   0.93 (0.72, 1.19)  
C-section delivery Yes 198 34.0   1.00 0.54 (0.37, 0.80)**
No 1072 44.7 0.016 1.57 (1.09, 2.26)* 1.00
Quality of 4+ ANC visits Poor 547 33.2  < 0.001 1.00 1.00
Optimal 723 50.4   2.05 (1.60, 2.63)*** 1.78 (1.33, 2.38)***
  1. Significance at ***p < 0.001, **p < 0.01, *p < 0.05. Hosmer Lemeshow test (p = 0.879)