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Essential neonatal care utilization and associated factors among
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underprivileged ethnic groups in Midwest Nepal: A mixed method
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study
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*Corresponding author: Keshab Sanjel (keshabsanjel@gmail.com); Tel: +977-9851228317
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Abstract
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Background
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Globally in 2017 neonatal death accounted for 46% of under-five deaths. Nepal is one of the
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developing countries which have a high number of neonatal deaths. The rates are high among
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poor socio-economic groups, marginalized, as well as people living in remote areas of Nepal.
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This paper thus tries to examine the utilization pattern and maternal, household, and health
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service factors affecting among underprivileged ethnic groups in Midwest Nepal.
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Methods
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A cross-sectional mixed methods study was conducted from September 2017 to April 2018 in
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Bardiya district. Quantitative data were from a household survey of women who gave live births
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within the last 12 months prior to data collection (n= 362). Ten key informant interviews with
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purposively selected informants were conducted as well. The Logistic regression model was
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used to determine the factors associated with essential neonatal care utilization. The recording,
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note keeping, transcription, and thematic content analysis were conducted for the qualitative
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data.
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Results
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Overall, the status of neonatal care utilization in this study was found as 58.6% (53.3%-63.7%),
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with big variations seen in the coverage of selected neonatal care components. Factors such as
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birth order (2.059, 1.129-3.752), ethnicity (2.277, 1.327-3.909), religion (2.368, 1.027-5.456),
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perceived quality of maternal and neonatal services (2.661, 1.613-4.391) and awareness on
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immediate essential newborn cares (2.223, 1.277-3.870) were identified as the factors affecting
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neonatal care utilization.
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Conclusions
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The status of essential neonatal care utilization, particularly, the coverage of planned for birth
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and its complications, adequate breastfeeding, and postnatal care attendance were very low as
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compared to the national target for each component. Factors affecting neonatal care exist at
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maternal, household as well as health system level and included ethnicity, religion, perceived
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quality of maternal and neonatal services, birth order and awareness on immediate essential
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newborn care. Implementation of targeted interventions along the continuum of care, improving
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the quality of maternal and neonatal care services at health facilities and raising mother’s level
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of awareness about neonatal care are recommended.
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