Impact of investment case on equitable access to maternal and child health services in Nepal: a quasi-experimental study

Abstract Background Disparities in the use of maternal, neonatal and child health (MNCH) services remain a concern in Low- and Middle-Income countries such as Nepal. Commonly observed disparities exist in education, income, ethnic groups, administrative regions and province-level in Nepal. In order...

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Autores principales:	Janak Kumar Thapa, Doris Stöckl, Raj Kumar Sangroula, Dip Narayan Thakur, Suresh Mehata, Asha Pun, Maria Delius
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Investment case approach Maternal and child health Nepal Quasi experimental Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/af812a16b5f44a34989e58f048fe5e71
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spelling	oai:doaj.org-article:af812a16b5f44a34989e58f048fe5e712021-12-05T12:06:53ZImpact of investment case on equitable access to maternal and child health services in Nepal: a quasi-experimental study10.1186/s12913-021-07292-51472-6963https://doaj.org/article/af812a16b5f44a34989e58f048fe5e712021-12-01T00:00:00Zhttps://doi.org/10.1186/s12913-021-07292-5https://doaj.org/toc/1472-6963Abstract Background Disparities in the use of maternal, neonatal and child health (MNCH) services remain a concern in Low- and Middle-Income countries such as Nepal. Commonly observed disparities exist in education, income, ethnic groups, administrative regions and province-level in Nepal. In order to improve equitable outcomes for MNCH and to scale-up quality services, an Investment Case (IC) approach was lunched in the Asia Pacific region. The study assessed the impact of the IC intervention package in maternal and child health outcomes in Nepal. Methods The study used a quasi-experimental design extracting data from the Nepal Demographic Health Surveys – 2011 (pre-assessment) and 2016 (post-assessment) for 16 intervention and 24 control districts. A Difference in Difference (DiD) analysis was conducted to assess the impact of the intervention on maternal and child health outcomes. The linear regression method was used to calculate the DiD, adjusting for potential covariates. The final models were arrived by stepwise backward method including the confounding variables significant at p < 0.05. Results The results of the DiD analyses showed at least four antenatal care visits (ANC) decreased in the intervention area (DiD% = − 4.8), while the delivery conducted by skilled birth attendants increased (DiD% = 6.6) compared to control area. However, the adjusted regression coefficient showed that these differences were not significant, indicating a null effect of the intervention. Regarding the child health outcomes, children with underweight (DiD% = 6.3), and wasting (DiD% = 5.4) increased, and stunting (DiD% = − 6.3) decreased in the intervention area compared to control area. The adjusted regression coefficient showed that the difference was significant only for wasting (β = 0.019, p = 0.002), indicating the prevalence of wasting increased in the intervention group compared to the control group. Conclusion The IC approach implemented in Nepal did not show improvements in maternal and child health outcomes compared to control districts. The use of the IC approach to improve MCH in Nepal should be discussed and, if further used, the process of implementation should be strictly monitored and evaluated.Janak Kumar ThapaDoris StöcklRaj Kumar SangroulaDip Narayan ThakurSuresh MehataAsha PunMaria DeliusBMCarticleInvestment case approachMaternal and child healthNepalQuasi experimentalPublic aspects of medicineRA1-1270ENBMC Health Services Research, Vol 21, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Investment case approach Maternal and child health Nepal Quasi experimental Public aspects of medicine RA1-1270
spellingShingle	Investment case approach Maternal and child health Nepal Quasi experimental Public aspects of medicine RA1-1270 Janak Kumar Thapa Doris Stöckl Raj Kumar Sangroula Dip Narayan Thakur Suresh Mehata Asha Pun Maria Delius Impact of investment case on equitable access to maternal and child health services in Nepal: a quasi-experimental study
description	Abstract Background Disparities in the use of maternal, neonatal and child health (MNCH) services remain a concern in Low- and Middle-Income countries such as Nepal. Commonly observed disparities exist in education, income, ethnic groups, administrative regions and province-level in Nepal. In order to improve equitable outcomes for MNCH and to scale-up quality services, an Investment Case (IC) approach was lunched in the Asia Pacific region. The study assessed the impact of the IC intervention package in maternal and child health outcomes in Nepal. Methods The study used a quasi-experimental design extracting data from the Nepal Demographic Health Surveys – 2011 (pre-assessment) and 2016 (post-assessment) for 16 intervention and 24 control districts. A Difference in Difference (DiD) analysis was conducted to assess the impact of the intervention on maternal and child health outcomes. The linear regression method was used to calculate the DiD, adjusting for potential covariates. The final models were arrived by stepwise backward method including the confounding variables significant at p < 0.05. Results The results of the DiD analyses showed at least four antenatal care visits (ANC) decreased in the intervention area (DiD% = − 4.8), while the delivery conducted by skilled birth attendants increased (DiD% = 6.6) compared to control area. However, the adjusted regression coefficient showed that these differences were not significant, indicating a null effect of the intervention. Regarding the child health outcomes, children with underweight (DiD% = 6.3), and wasting (DiD% = 5.4) increased, and stunting (DiD% = − 6.3) decreased in the intervention area compared to control area. The adjusted regression coefficient showed that the difference was significant only for wasting (β = 0.019, p = 0.002), indicating the prevalence of wasting increased in the intervention group compared to the control group. Conclusion The IC approach implemented in Nepal did not show improvements in maternal and child health outcomes compared to control districts. The use of the IC approach to improve MCH in Nepal should be discussed and, if further used, the process of implementation should be strictly monitored and evaluated.
format	article
author	Janak Kumar Thapa Doris Stöckl Raj Kumar Sangroula Dip Narayan Thakur Suresh Mehata Asha Pun Maria Delius
author_facet	Janak Kumar Thapa Doris Stöckl Raj Kumar Sangroula Dip Narayan Thakur Suresh Mehata Asha Pun Maria Delius
author_sort	Janak Kumar Thapa
title	Impact of investment case on equitable access to maternal and child health services in Nepal: a quasi-experimental study
title_short	Impact of investment case on equitable access to maternal and child health services in Nepal: a quasi-experimental study
title_full	Impact of investment case on equitable access to maternal and child health services in Nepal: a quasi-experimental study
title_fullStr	Impact of investment case on equitable access to maternal and child health services in Nepal: a quasi-experimental study
title_full_unstemmed	Impact of investment case on equitable access to maternal and child health services in Nepal: a quasi-experimental study
title_sort	impact of investment case on equitable access to maternal and child health services in nepal: a quasi-experimental study
publisher	BMC
publishDate	2021
url	https://doaj.org/article/af812a16b5f44a34989e58f048fe5e71
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Impact of investment case on equitable access to maternal and child health services in Nepal: a quasi-experimental study

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