title: Predisposing, enabling, and need factors associated with utilization of institutional delivery services: A community-based cross-sectional study in far-western Nepal.
abstract: Use of institutional delivery services can be effective in reducing maternal and infant mortality. In Nepal, however, the majority of women deliver at home. Using Andersen's behavioral model of use of health care services, this cross-sectional study aimed to identify factors associated with use of institutional delivery services in four villages and one municipality in Kailali district, Nepal. Mothers (N = 500) who had given birth in the 5 years preceding the survey (conducted between January and February 2015) were randomly selected by cluster sampling and interviewed using a semi-structured questionnaire. Bivariate analyses and multivariate hierarchical logistic regression analyses were performed. Among the women surveyed, 65.6% had used institutional delivery services for their last delivery, a higher proportion than the national average. Primiparity, having a secondary or higher education level, living in the Durgauli village, having husbands with occupations other than agriculture or professional/technical jobs, and having attended four or more antenatal care (ANC) visits had significantly increased use of institutional deliveries. Also, belonging to the richest 20% of the community and having experienced pregnancy complications were marginally significantly associated. These findings demonstrate the need for improving mother's education, encouraging them to attend ANC visits and addressing disparities between different regions.
authors.affiliation: a Department of Preventive Medicine , Wonju College of Medicine, Yonsei University , Wonju City , Gangwon-Do , South Korea.|b Institute for Poverty Alleviation and International Development , Yonsei University , Wonju City , Gangwon-Do , South Korea.
authors.forename: Leila
authors.initials: L
authors.lastname: Freidoony
authors.affiliation: a Department of Preventive Medicine , Wonju College of Medicine, Yonsei University , Wonju City , Gangwon-Do , South Korea.|b Institute for Poverty Alleviation and International Development , Yonsei University , Wonju City , Gangwon-Do , South Korea.|c Health Science Foundations and Study Center , Kathmandu , Nepal.
authors.forename: Chhabi Lal
authors.initials: CL
authors.lastname: Ranabhat
authors.affiliation: a Department of Preventive Medicine , Wonju College of Medicine, Yonsei University , Wonju City , Gangwon-Do , South Korea.|b Institute for Poverty Alleviation and International Development , Yonsei University , Wonju City , Gangwon-Do , South Korea.
authors.forename: Chun-Bae
authors.initials: CB
authors.lastname: Kim
authors.affiliation: b Institute for Poverty Alleviation and International Development , Yonsei University , Wonju City , Gangwon-Do , South Korea.|d Department of Business Administration , College of Government and Business, Yonsei University, Yonsei University , Wonju City , Gangwon-Do , South Korea.
authors.forename: Chang-Soo
authors.initials: CS
authors.lastname: Kim
authors.affiliation: b Institute for Poverty Alleviation and International Development , Yonsei University , Wonju City , Gangwon-Do , South Korea.|d Department of Business Administration , College of Government and Business, Yonsei University, Yonsei University , Wonju City , Gangwon-Do , South Korea.
authors.forename: Dong-Won
authors.initials: DW
authors.lastname: Ahn
authors.affiliation: e Africa and South America Section , Korea International Co-operation Agency , Addis Ababa , Ethiopia.
authors.forename: Young Ah
authors.initials: YA
authors.lastname: Doh
mesh_terms: D000293:Adolescent; D000328:Adult; D055812:Community-Based Participatory Research; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D009390:Nepal; D036801:Parturition; D011295:Prenatal Care / Q000523:psychology / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D018454:Spouses; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Antenatal care; Nepal; institutional delivery; maternal education; maternal health; pregnancy