Health system-related characteristics.

BackgroundIt is crucial to deliver a child at nearby primary healthcare facilities to prevent subsequent maternal or neonatal complications. In low-resource settings, such as Nepal, it is customary to forgo the neighboring primary healthcare facilities for child delivery. Reports are scanty about the extent and reasons for bypassing local health centers in Nepal. This study sought to determine the prevalence and contributing factors among women bypassing primary healthcare facilities for childbirth.MethodA community-based cross-sectional study was carried out in the Devchuli municipality of Nawalparasi East district of Nepal. Utilizing an online data collection tool, structured interviews were conducted among 314 mothers having a child who is less than one year of age.ResultsThis study showed that 58.9% of the respondents chose to bypass their nearest primary healthcare facility to deliver their babies in secondary or tertiary hospitals. Respondent’s husband’s employment status; informal employment (AOR: 4.2; 95% CI: 1.8–10.2) and formal employment (AOR: 3.2; 95% CI: 1.5–6.8), wealth quintile (AOR: 3.7; 95% CI: 1.7–7.7), parity (AOR): 3.0; 95% CI: 1.6–5.7], distance to nearest primary healthcare facility by the usual mode of transportation (AOR: 3.0; 95% CI: 1.5–5.6) and perceived service quality of primary healthcare facility (AOR: 3.759; 95% CI: 2.0–7.0) were associated with greater likelihood of bypassing primary healthcare facility.ConclusionEnhancing the quality of care, and informing beneficiaries about the importance of delivering children at primary healthcare facilities are essential for improving maternal service utilization at local primary healthcare facilities.

背景：分娩应在邻近的基层医疗卫生机构（primary healthcare facilities）开展，这是预防后续产妇及新生儿并发症的关键举措。在尼泊尔等资源匮乏地区，民众通常会选择放弃就近的基层医疗卫生机构进行分娩。目前针对尼泊尔民众绕过当地卫生中心分娩的比例及动因的相关研究报道十分匮乏。本研究旨在明确分娩时绕过基层医疗卫生机构的女性群体的占比及其影响因素。
方法：本研究在尼泊尔纳瓦尔帕拉西县东部的德夫丘利市实施一项基于社区的横断面研究（cross-sectional study）。通过在线数据采集工具，对314名家中幼儿不足1周岁的母亲开展结构化访谈。
结果：本研究结果显示，58.9%的受访者选择绕过就近的基层医疗卫生机构，前往二级或三级医院完成分娩。受访者丈夫的就业状态：非正规就业（调整后优势比（Adjusted Odds Ratio, AOR）=4.2，95%置信区间（Confidence Interval, CI）=1.8~10.2）、正规就业（AOR=3.2，95%CI=1.5~6.8）、财富五分位（AOR=3.7，95%CI=1.7~7.7）、产次（AOR=3.0，95%CI=1.6~5.7）、常用出行方式下抵达最近基层医疗卫生机构的距离（AOR=3.0，95%CI=1.5~5.6）以及对基层医疗卫生机构的感知服务质量（AOR=3.759，95%CI=2.0~7.0），均与绕过基层医疗卫生机构分娩的可能性显著相关。
结论：提升医疗服务质量，并向服务对象告知在基层医疗卫生机构分娩的重要性，对于提高当地基层医疗卫生机构的产科服务利用率具有重要意义。