Severe maternal and neonatal morbidity status and qualitative exploration of high-risk, referral refusals and quality of care in Morang district, Nepal

Early identification of pregnant women at risk of developing complications at birth, is fundamental to antenatal care (ANC) and an important strategy to prevent maternal death. The availability of services does not always increase their use. The quality of care should be monitored based on patients’...

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Main Author:	Rajbanshi, Sushma
Format:	Thesis
Language:	English
Published:	2021
Subjects:	R Medicine
Online Access:	http://eprints.usm.my/49892/1/SUSHMA%20RAJBANSHI-FINAL%20THESIS%20P-UD000119%28R%29_-24%20pages.pdf
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spelling	my-usm-ep.498922021-09-13T08:55:03Z Severe maternal and neonatal morbidity status and qualitative exploration of high-risk, referral refusals and quality of care in Morang district, Nepal 2021-03 Rajbanshi, Sushma R Medicine Early identification of pregnant women at risk of developing complications at birth, is fundamental to antenatal care (ANC) and an important strategy to prevent maternal death. The availability of services does not always increase their use. The quality of care should be monitored based on patients’ perceptions. This study aims to determine the magnitude of risk stratification, severe maternal morbidity (SMM), and a neonatal near miss (NNM). It further explored association between risk stratification and SMM and the associated factors of SMM and NNM. This study explored the meaning of high-risk pregnancy, the barriers to non-adherence to referral services and the perceptions of good-quality antenatal and birthing services among women with high-risk factors. This was a concurrent mixed-method study where hospital-based prospective cohort study, a cross-sectional study and a phenomenological study was applied. A total of 346 pregnant women, 1000 newborns and 14 participants with high-risk factors were enrolled. The quantitative study was conducted at Koshi Hospital and qualitative study within Morang district in Nepal. Multiple logistic regression analyses and thematic analysis were performed. The prevalence of high-risk pregnancy was 14.4%, SMM 6.6%, and NNM 7.9%. Risk stratification and SMM were significantly associated. Maternal education was significantly associated with SMM. Illiteracy, multiparity, SMM, and caesarean section were associated with NNM. Nine themes emerged in the qualitative study: (i) knowledge and understanding of risk, (ii) normalizing and non-acceptance of risk, (iii) preference of homebirth, (iv) women’s diminished autonomy and financial dependence, (v) conditional factors, (vi) sociocultural factors, (vii) women’s opinions and satisfactory factors of health services, (viii) expectations of the health facility and staff, (ix) a lack of suggestions to improve the quality of care.Women with high-risk factors were four times more likely to develop SMM conditions than low-risk women. Routine ANC follow-up could identify and prevent high-risk factors related complications in pregnancy and is recommended to be used. Healthcare providers should be aware that risk perception is a subjective matter. Although risk in pregnancy or childbirth is communicated, women may not be fully convinced or deny that they are at risk. Adherence to a referral for hospital birth among high-risk pregnant women was poor among the poorest segments. They lack knowledge of their basic reproductive rights. Women judge the quality of care in terms of staff interpersonal behavior, free drug supply, personal experiences, or based on their relative’s recommendations. 2021-03 Thesis http://eprints.usm.my/49892/ http://eprints.usm.my/49892/1/SUSHMA%20RAJBANSHI-FINAL%20THESIS%20P-UD000119%28R%29_-24%20pages.pdf application/pdf en public phd doctoral Universiti Sains Malaysia Pusat Pengajian Sains Perubatan
institution	Universiti Sains Malaysia
collection	USM Institutional Repository
language	English
topic	R Medicine
spellingShingle	R Medicine Rajbanshi, Sushma Severe maternal and neonatal morbidity status and qualitative exploration of high-risk, referral refusals and quality of care in Morang district, Nepal
description	Early identification of pregnant women at risk of developing complications at birth, is fundamental to antenatal care (ANC) and an important strategy to prevent maternal death. The availability of services does not always increase their use. The quality of care should be monitored based on patients’ perceptions. This study aims to determine the magnitude of risk stratification, severe maternal morbidity (SMM), and a neonatal near miss (NNM). It further explored association between risk stratification and SMM and the associated factors of SMM and NNM. This study explored the meaning of high-risk pregnancy, the barriers to non-adherence to referral services and the perceptions of good-quality antenatal and birthing services among women with high-risk factors. This was a concurrent mixed-method study where hospital-based prospective cohort study, a cross-sectional study and a phenomenological study was applied. A total of 346 pregnant women, 1000 newborns and 14 participants with high-risk factors were enrolled. The quantitative study was conducted at Koshi Hospital and qualitative study within Morang district in Nepal. Multiple logistic regression analyses and thematic analysis were performed. The prevalence of high-risk pregnancy was 14.4%, SMM 6.6%, and NNM 7.9%. Risk stratification and SMM were significantly associated. Maternal education was significantly associated with SMM. Illiteracy, multiparity, SMM, and caesarean section were associated with NNM. Nine themes emerged in the qualitative study: (i) knowledge and understanding of risk, (ii) normalizing and non-acceptance of risk, (iii) preference of homebirth, (iv) women’s diminished autonomy and financial dependence, (v) conditional factors, (vi) sociocultural factors, (vii) women’s opinions and satisfactory factors of health services, (viii) expectations of the health facility and staff, (ix) a lack of suggestions to improve the quality of care.Women with high-risk factors were four times more likely to develop SMM conditions than low-risk women. Routine ANC follow-up could identify and prevent high-risk factors related complications in pregnancy and is recommended to be used. Healthcare providers should be aware that risk perception is a subjective matter. Although risk in pregnancy or childbirth is communicated, women may not be fully convinced or deny that they are at risk. Adherence to a referral for hospital birth among high-risk pregnant women was poor among the poorest segments. They lack knowledge of their basic reproductive rights. Women judge the quality of care in terms of staff interpersonal behavior, free drug supply, personal experiences, or based on their relative’s recommendations.
format	Thesis
qualification_name	Doctor of Philosophy (PhD.)
qualification_level	Doctorate
author	Rajbanshi, Sushma
author_facet	Rajbanshi, Sushma
author_sort	Rajbanshi, Sushma
title	Severe maternal and neonatal morbidity status and qualitative exploration of high-risk, referral refusals and quality of care in Morang district, Nepal
title_short	Severe maternal and neonatal morbidity status and qualitative exploration of high-risk, referral refusals and quality of care in Morang district, Nepal
title_full	Severe maternal and neonatal morbidity status and qualitative exploration of high-risk, referral refusals and quality of care in Morang district, Nepal
title_fullStr	Severe maternal and neonatal morbidity status and qualitative exploration of high-risk, referral refusals and quality of care in Morang district, Nepal
title_full_unstemmed	Severe maternal and neonatal morbidity status and qualitative exploration of high-risk, referral refusals and quality of care in Morang district, Nepal
title_sort	severe maternal and neonatal morbidity status and qualitative exploration of high-risk, referral refusals and quality of care in morang district, nepal
granting_institution	Universiti Sains Malaysia
granting_department	Pusat Pengajian Sains Perubatan
publishDate	2021
url	http://eprints.usm.my/49892/1/SUSHMA%20RAJBANSHI-FINAL%20THESIS%20P-UD000119%28R%29_-24%20pages.pdf
_version_	1747822020943413248

Severe maternal and neonatal morbidity status and qualitative exploration of high-risk, referral refusals and quality of care in Morang district, Nepal

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