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      Maternal health and its affecting factors in Nepal

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          Abstract

          Maternal health is still a public health problem in developing countries, especially in low-resource settings rural and poor communities. The main aim of this article is to critically evaluate and explore the situation of maternal health in Nepal based on published or unpublished governmental or nongovernmental organization’s scientific reports regarding maternal health. We found that there were several direct or indirect causes and affecting factors of maternal death in Nepal, which are preventable. Women have been facing different consequences during pregnancy and delivery, attributed to lack of proper knowledge or less available and affordable health facilities in rural communities. Therefore, there is needed an essential maternal health knowledge to women and also establish health facilities with a quality health care service on affordable and accessible to prevent maternal death and minimize complications.

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          Most cited references29

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          Family planning: the unfinished agenda.

          Promotion of family planning in countries with high birth rates has the potential to reduce poverty and hunger and avert 32% of all maternal deaths and nearly 10% of childhood deaths. It would also contribute substantially to women's empowerment, achievement of universal primary schooling, and long-term environmental sustainability. In the past 40 years, family-planning programmes have played a major part in raising the prevalence of contraceptive practice from less than 10% to 60% and reducing fertility in developing countries from six to about three births per woman. However, in half the 75 larger low-income and lower-middle income countries (mainly in Africa), contraceptive practice remains low and fertility, population growth, and unmet need for family planning are high. The cross-cutting contribution to the achievement of the Millennium Development Goals makes greater investment in family planning in these countries compelling. Despite the size of this unfinished agenda, international funding and promotion of family planning has waned in the past decade. A revitalisation of the agenda is urgently needed. Historically, the USA has taken the lead but other governments or agencies are now needed as champions. Based on the sizeable experience of past decades, the key features of effective programmes are clearly established. Most governments of poor countries already have appropriate population and family-planning policies but are receiving too little international encouragement and funding to implement them with vigour. What is currently missing is political willingness to incorporate family planning into the development arena.
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            Socioeconomic and physical distance to the maternity hospital as predictors for place of delivery: an observation study from Nepal

            Background Although the debate on the safety and women's right of choice to a home delivery vs. hospital delivery continues in the developed countries, an undesirable outcome of home delivery, such as high maternal and perinatal mortality, is documented in developing countries. The objective was to study whether socio-economic factors, distance to maternity hospital, ethnicity, type and size of family, obstetric history and antenatal care received in present pregnancy affected the choice between home and hospital delivery in a developing country. Methods This cross-sectional study was done during June, 2001 to January 2002 in an administratively and geographically well-defined territory with a population of 88,547, stretching from urban to adjacent rural part of Kathmandu and Dhading Districts of Nepal with maximum of 5 hrs of distance from Maternity hospital. There were no intermediate level of private or government hospital or maternity homes in the study area. Interviews were carried out on 308 women who delivered within 45 days of the date of the interview with a pre-tested structured questionnaire. Results A distance of more than one hour to the maternity hospital (OR = 7.9), low amenity score status (OR = 4.4), low education (OR = 2.9), multi-parity (OR = 2.4), and not seeking antenatal care in the present pregnancy (OR = 4.6) were statistically significantly associated with an increased risk of home delivery. Ethnicity, obstetric history, age of mother, ritual observance of menarche, type and size of family and who is head of household were not statistically significantly associated with the place of delivery. Conclusions The socio-economic standing of the household was a stronger predictor of place of delivery compared to ethnicity, the internal family structure such as type and size of family, head of household, or observation of ritual days by the mother of an important event like menarche. The results suggested that mothers, who were in the low-socio-economic scale, delivered at home more frequently in a developing country like Nepal.
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              Financial implications of skilled attendance at delivery in Nepal.

              To measure costs and willingness-to-pay for delivery care services in 8 districts of Nepal. Household costs were used to estimate total resource requirements to finance: (1) the current pattern of service use; (2) all women to deliver in a health facility; (3) skilled attendance at home deliveries with timely referral of complicated cases to a facility offering comprehensive obstetric services. The average cost to a household of a home delivery ranged from 410 RS (5.43 dollars) (with a friend or relative attending) to 879 RS (11.63 dollars) (with a health worker). At a facility the average fee for a normal delivery was 678 RS (8.97 dollars). When additional charges, opportunity and transport costs were added, the total amount paid exceeded 5,300 RS (70 dollars). For a caesarean section the total household cost was more than 11,400 RS (150 dollars). Based on these figures, the cost of financing current practice is 45 RS (0.60 dollar) per capita. A policy of universal institutional delivery would cost 238 RS (3.15 dollars) per capita while a policy of skilled attendance at home with early referral of cases from remote areas would cost around 117 RS (1.55 dollars) per capita. These are significant sums in the context of a health budget of about 400 RS (5 dollars) per capita. Conclusions The financial cost of developing a skilled attendance strategy in Nepal is substantial. The mechanisms to direct funding to women in need must to be improved, pricing needs to be more transparent, and payment exemptions in public facilities must be better financed if we are to overcome both supply and demand-side barriers to care seeking.
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                Author and article information

                Journal
                FMCH
                Family Medicine and Community Health
                FMCH
                Compuscript (Ireland )
                2009-8774
                2305-6983
                July 2016
                August 2016
                : 4
                : 3
                : 30-34
                Affiliations
                [1] 1Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China
                [2] 2Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
                [3] 3School of Health and Well–Being, University of Wolverhampton, UK
                [4] 4Ashwani Ayruvedic Hospital, Kerala, India
                [5] 5School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
                Author notes
                CORRESPONDING AUTHORS: Xiuhua Guo, PhD, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, You’anmen Wai, Fengtai District, Beijing 100069, China, Tel.: +86-10-83911508, Fax: +86-10-83911508, E-mail: guoxiuh@ 123456ccmu.edu.cn , Gehendra Mahara, PhD Fellow, Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You’anmen Wai, Fengtai District, Beijing 100069, China, E-mail: gbmahara@ 123456gmail.com
                Article
                FMCH.2015.0155
                10.15212/FMCH.2015.0155
                a39c43bd-c88c-40d5-b85d-27cb42026f3a
                Copyright © 2016 Family Medicine and Community Health

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

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                Self URI (journal page): http://fmch-journal.org/
                Categories
                Review

                General medicine,Medicine,Geriatric medicine,Occupational & Environmental medicine,Internal medicine,Health & Social care
                maternal mortality,Maternal health,Nepal

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