Continuity of care and its determinants of routine maternal and newborn health visits in Nepal: Evidence from a nationally representative household survey

Background: Maternal and newborn health (MNH) is a priority health issue in Nepal, has high maternal and neonatal deaths. Maternal and neonatal deaths can be prevented through uptake of essential antenatal, intrapartum, and postnatal interventions received during routine MNH visits. Not all women, however, receive all recommended routine visits across the MNH Continuum of Care (CoC) in Nepal. This study examined the patterns and determinants of (dis)continuity of care across the MNH continuum. Methods: The study included 1,978 women aged 15–49 years who had a live birth in the two years preceding the survey. Data were derived from the Nepal Demographic and Health Survey (NDHS) 2016. The outcome variable was (dis)continuity of care at different stages of MNH visits (at least four antenatal care (4ANC) visits, institutional delivery, and postnatal care (PNC) visit). Several structural, intermediary and health system explanatory variables were included in the analysis. Multinomial logistic regression analysis was conducted, and the magnitude of (dis)continuity of care was reported as relative risk ratios (RR) with 95% confidence intervals (CIs). The statistical significance level was set p<0.05. Results: More than two-in-five (41%) women in Nepal received all three MNH visits across the CoC. There was high risk of discontinuity of care during months or weeks prior to childbirth or around childbirth. Higher risk of discontinuation across the CoC was reported among women of disadvantaged ethnic groups, lower wealth status and illiterate. Similarly, women who speak Bhojpuri, provinces six and seven, who had higher birth order (≥4), who involved in agricultural sector, had unwanted last birth had higher risk of discontinuation of MNH visits. Women did not complete all MNH visits if they had poor awareness on health mother groups and if they perceived problem of not having female healthcare providers. Conclusions: Women had poor completion of all routine MNH visits. High discontinuation was observed among disadvantaged groups across the COC. Regular monitoring using the composite indicator of continuity of care through routine health management information system is required. Program approaches should focus on disadvantaged women to improve the completion of routine MNH visits and uptake of essential interventions.