Exploring Factors Influencing Antenatal Care Visit Dropout at Government Health Facilities of Dhanusha District, Nepal

摘要

Background: High maternal mortality rate is still a major public health issue in resource poor countries. In Nepal, the regional socio-economic disparity explicitly reflects inequalities in maternal health service utilization and differences in maternal mortality rate. Only about 50% of pregnant women complete four antenatal care visits. Nearly 80% delivery is still conducted at home in absence of trained health worker among Terai/Madheshi dalits communities in Nepal. The present study intended to explore the factors influencing antenatal care visit dropout at government health facilities of Dhanusha district in Nepal. Methods: This is a descriptive cross sectional study. A total sample of 206 women who had received at least 1st ANC check up from the government health facility during March 2014 to March 2015 were selected using multistage sampling procedure. Interview method was adopted and semi-structure questionnaire was used to gather the study data. Data analysis was carried out in SPSS 20. Ethical clearance was taken from Nepal Health Research Council Ethical Review Board. Results: Out of total 206 respondents 104 (49.52%) of respondents have completed four ANC visits and 106 (50.47%) respondents have not completed four ANC visits. The study confirmed the significant association of antenatal visit dropout with respondents education (OR= 2.22, 95% CI= 1.264-3.917), economic status (OR= 2.37, 95% CI= 1.264-4.462, dissatisfaction with the health service provided at public health facilities (OR=17.48, 95% CI=8.764-34.88), dissatisfaction with the information provided during ANC visit (OR= 0.167, 95% CI=0.092-0.303) and unreceptive attitude of health worker (OR=3.766, 95% CI=2.095-6.769) as major hindering factors among respondents for not attending four ANC visit at government/public health facilities in Dhanusha district of Nepal. Conclusion: The study suggests promotion of positive attitude and behavior of health workers towards clients and building trust on government health facilities from health care provider side are equally important to increase antenatal service utilization among rural pregnant women.