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Background: Utilization of ANC services was low in Nepal despite the significant efforts to maximize its services, i.e. four ANC visits with Skill Birth Attendant, 2 TT vaccines and at least 180 days for Iron folic tablets for pregnant women. Moreover, the prevalence of received prenatal services among rural mothers was lower than the urban mothers. Addressing maternal health requires the understanding of ANC services received by mothers during the designing and delivering of ANC Services to the rural mothers.
Objectives: the present study was conducted to assess the factors that determine the utilization of antenatal care services in terms of ANC visits with health personnel, receiving days of iron tablets & number of took TT vaccine in rural area of Nepal.
Methods: Both bivariate and multivariate approaches were used to determine the associated factors for receiving ANC services. Independent t test was used to compare the mean difference of ANC visits and number of iron receiving days based on mother's characteristics. Significantly associated variables in independent t test were applied for linear regression model. To determine the associated factors of 2 TT vaccines, univariate and multivariate binary logistic model was applied. Statistically significant variables in univariate binary logistic model were applied for multivariate model. P-values less than 0.05 were considered as significant.
Results: Ethnicity and types of family were significantly associated with 4 ANC visits in multivariate linear model. Mothers from Brahmin/Chhetri ethnicity and Joint family had higher ANC visits than Dalit/Janajati and Nuclear family mothers (P < 0.001, P = 0.004 respectively). Only ethnicity was found significant predictor for receiving 180 days iron tablets, as Dalit/Janajati mothers had lower iron receiving days (P < 0.001). The multivariate analysis showed that education and parity were the strong influencing factors for completing 2 TT vaccines during pregnancy. Literate mothers were more likely to complete 2 TT vaccine (OR = 2.338, P = 0.028). Similarly, the likelihood for completing 2 TT vaccines among primiparous mothers were 2.7 times higher than multiparous mothers (P = 0.006).
Conclusion: Ethnicity is seen influencing factor of ANC visits and iron receiving days; also the type of family appeared as the significant predictor of ANC visits. Education of mothers and parity are found as the factors associated with TT vaccine of pregnant women in rural area. Hence, efforts should be directed towards Dalit/Janajati mothers to receive ANC services. It is also essential to uplift the awareness of the family/mothers about the availability of prenatal services and family planning program.
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Author(s): Ramesh Kumar Dahal
ANC services, Iron tablets, TT vaccine, Linear Regression, Binary Logistic