Pattern of Institutional delivery in Dadeldhura district of Nepal: A cross-sectional study

Background: Maternal mortality ratio of Nepal is one of the highest (380/100000 live births) among the South East Asian countries, where majority of the births take place at home without the assistance of skilled attendant. Latest estimates revealed that only 36.0% births were attended by skilled attendants in Nepal. Objective: To examine the pattern of institutional deliveries among the mothers in Dadeldhura District of Nepal. Materials and Methods: A community-based cross-sectional quantitative study was conducted in Dadeldhura district during October 2012 to March 2013 among 516 mothers who delivered within last 1 year. In addition, 3 years records of District Health Office, Dadeldhura were reviewed. Data were collected by trained enumerators through face to face interview using structured interview schedule. Data were analyzed by SPSS (17.0 versions). Percentage, mean, median, standard deviation, and range were calculated. Results: Mean age of the participants was 24.76 ± 3.77 years. The combined proportion of Dalit and Chhetri was 82.8%. About 17.6% participants were illiterates and 81.6% agriculture workers. About 95% had done one time antenatal care (ANC) visit, while only 64.8% had four time ANC visits during index pregnancy. Majority (82.2%) had received ANC services from primary level health facilities. Almost 77.3% had institutional delivery; among them 59.6% delivered at primary level health facilities. About two-third went to facility on foot, where 45.4% accessed delivery care from a health facility with an approximate distance of >5 km. Almost 55.0% had knowledge of at least one complication occurring during delivery and 74.0% were known about the safe delivery incentive program. Conclusions: Institutional delivery rate was good (77.3%) as against national average (37.0%). Majority (59.6%) had delivery at primary level health facilities. Three quarters were known about Safe Delivery Incentive Programme. Strengthening the capacity of primary level health care facilities in terms of skilled attendants and materials to cater the growing acceptance of local level health facility is recommended to scale up safe delivery practices