CARE DURING PREGNANCY AND DELIVERY: IMPLICATIONS FOR PROTECTING THE HEALTH OF MOTHERS AND THEIR BABIES (Fifth Cycle)

CARE DURING PREGNANCY AND DELIVERY: IMPLICATIONS FOR PROTECTING THE HEALTH OF MOTHERS AND THEIR BABIES
(Final Rreport)

NEPAL MULTIPLE INDICATOR SURVEILLANCE
Fifth Cycle: March-May 1997

His Majesty's Government/Nepal-National Planning Commission Secretariat, Kathmandu

In Collaboration with UNICEF-Nepal

June 1998

Preface

His Majesty's Government of Nepal has shown its commitment to the development of children through the ratification of United Nations Convention, summit and regional conferences. In line with the commitments, the government has prepared a Ten Years National Programme of Action for Children and Development for the 1990s. In the Programme of Action, goals for the 1996 and 2001 have also been set.

National Planning Commission is implementing series of Nepal Multiple Indicator Surveillance (NMIS) project to know the situation of children, and to provide basic data and analysis of indicators for effective national and local level planning. Further, NMIS also provides necessary data for monitoring and evaluating programmes on development of the children in line with the National Programme of Action.

This is the fifth cycle surveillance report which provides information on the utilization of Antinatal, Delivery and Postnatal services in Nepal. This report also indicates the areas where these services have been able to make positive impact and areas that are deficient and needs improvement.

The field work for NMIS Cycle - 5 was carried out by Central Bureau of Statistics (CBS) during the period of March - May, 1997. The data have also been analyzed in greater detail including the Polio coverage as well as Literacy which are available in CBS as further Analysis Report for the concerned institutions and individual.

National Planning Commission expresses its sincere appreciation to the members of NMIS Steering Committee, members of the Technical Committee for their valuable contributions and to CBS for conducting field work and analysis of findings. We also extend our appreciation to UNICEF for its professional facilitation as well as financial support and to CIET International for its technical inputs.

Singha Durbar
August, 1998

Dr. Bhola Nath Chalise
Member-Secretary
National Planning Commission
and
Chairperson of NMIS Steering Committee

NMIS STEERING COMMITTEE MEMBERS

Dr. Bhola Nath Chalise (From 9 February, 1998)
Mr. Punya Prasad Dahal (Till 8 February 1998)
Secretary, National Planning Commission Secretariat	-	Chair Person
Mr. Shree Bhagwan Singh	-	Member
Joint Secretary, National Planning Commission Secretariat
Representative	-	Member
Ministry of Education
Representative	-	Member
Ministry of Local Development
Dr. Chhatra Amatya	-	Member
Joint Secretary, Planning Division Ministry of Health
Representative
Ministry of Agriculture	-	Member
Mr. Keshav Raj Sharma	-	Member
Director General Central Bureau of Statistics
Representative	-	Member
Ministry of Women and Social welfare
Representative	-	Member
Ministry of Housing and Physical Planning
Mrs. Padma Mathema		Member
Under Secretary, Women and Social Welfare Section
National Planning Commission Secretariat
Mr. Gyanendra K. Shrestha		Member Secretary
Section Officer
National Planning Commission Secretariat

CIET International: (Instrument Design)
        Dr. Ann Cockroft, Consultant
Central Bureau of Statistics:
        Mrs Savitri Singh, Project Director
        Mr. Krishna Prasad Shrestha, Project Co-ordinator
UNICEF (Financial Support and Facilitation):
        Mr. Stewart McNab, Representative
        Mr. Fikre Y. Menkir, Planning Officer

NMIS TECHNICAL COMMITTEE

Mr. Krishna Prasad Shrestha	-	Chair Person
Deputy Director
Central Bureau of Statistics
Dr. Sanu Maiya Dali	-	Member
Consultant Gynaecologist
Dr. Q. Al Nahi
UNICEF	-	Member
Mr. Jyoti Raj Shrestha	-	Member
Sr. Public Health Officer
Ministry of Health
Mr. Mahesh Sharma	-	Member
Under Secretary, Ministry of Local Development
Mr. Ajit Singh Pradhan	-	Member
Demographer, Department of Health Services
Ms. Ranjana Shrestha	-	Member
Lalitpur Nursing Campus, Surendra Bhavan
Mr. Mahesh Parajuli	-	Member
Section Officer
Ministry of Education
Representative	-	Member
Ministry of Agriculture
Dr. Vijaya Manandhar	-	Member
WHO
Mr. Fikre Y. Menkir	-	Member
Planning Officer
UNICEF
Mr. Gyanendra Kumar Shrestha	-	Member Secretary
Section Officer

CONTENTS

Executive Summary
List of tables and figures
Abbreviations
Statistical and epidemiological terms

Introduction
Methods
Results I. Basic Indicators and risk analysis
        1. Antenatal care practices
                The women and their pregnancies
                Antenatal visits
                Other factors during pregnancy
                Variables affecting the likelihood of receiving antenatal care
                The quality of antenatal care
        2. Care during delivery
                Place of delivery
                Variables related to place of delivery
                Persons attending during labour
                Cost of delivery care
                Use of Home Delivery Kit
                Factors related to use of Home Delivery Kit
                Cutting of umbilical cord
                Treating the umbilical cord
                Duration of labour and problems during labour
                Referral of obstetric emergencies
                Health problems after birth
                Traditional birth attendants
        3. Risk analysis of delivery outcome
                a. Birth weight
                        Factors related to low birth weight
                b. Survival of newborn babies
                        Variables related to the survival of babies

Results II: Analysis for action
        1. Risk of not attending antenatal care
        2. Risk of low birth weight
        3. Risk of still birth and death soon after birth

        Action analysis
                Increase the proportion of women attending antenatal care
                Reduce low birth weight
                Reduce the risk of still birth and death soon after birth
                Priority interventions

References

Annexes
1. Sites in NMIS sample
2. Instruments used in NMIS Cycle 5
3. Frequencies of qualitative survey information
4. Weighted and unweighted values of key indicators
5. Results by geographic location and ethnic groups