{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T21:00:47Z","timestamp":1760821247795,"version":"3.41.2"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T00:00:00Z","timestamp":1615939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100008321","name":"Pennsylvania State University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008321","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Nick Simons Institute"},{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["P2CHD041025"],"award-info":[{"award-number":["P2CHD041025"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Nepal has made significant strides in maternal and neonatal mortality over the last three decades. However, poor quality of care can threaten the gains, as maternal and newborn services are particularly sensitive to quality of care. Our study aimed to understand current gaps in the process and the outcome dimensions of the quality of antenatal care (ANC), particularly at the sub-national level. We assessed these dimensions of the quality of ANC in 17 primary, public hospitals across Nepal. We also assessed the variation in the ANC process across the patients\u2019 socio-economic gradient.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We used a convergent mixed methods approach, whereby we triangulated qualitative and quantitative data. In the quantitative component, we observed interactions between providers (17 hospitals from all 7 provinces) and 198 women seeking ANC and recorded the tasks the providers performed, using the Service Provision Assessments protocol available from the Demographic and Health Survey program. The main outcome variable was the number of tasks performed by the provider during an ANC consultation. The tasks ranged from identifying potential signs of danger to providing counseling. We analyzed the resulting data descriptively and assessed the relationship between the number of tasks performed and users\u2019 characteristics. In the qualitative component, we synthesized users\u2019 and providers\u2019 narratives on perceptions of the overall quality of care obtained through focus group discussions and in-depth interviews.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Out of the 59 tasks recommended by the World Health Organization, providers performed only 22 tasks (37.3%) on average. The number of tasks performed varied significantly across provinces, with users in province 3 receiving significantly higher quality care than those in other provinces. Educated women were treated better than those with no education. Users and providers agreed that the overall quality of care was inadequate, although providers mentioned that the current quality was the best they could provide given the constraints they faced.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The quality of ANC in Nepal\u2019s primary hospitals is poor and inequitable across education and geographic gradients. While current efforts, such as the provision of 24\/7 birthing centers, can mitigate gaps in service availability, additional equipment, infrastructure and human resources will be needed to improve quality. Providers also need additional training focused on treating patients from different backgrounds equally. Our study also points to the need for additional research, both to document the quality of care more objectively and to establish key determinants of quality to inform policy.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/intqhc\/mzab049","type":"journal-article","created":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T12:11:51Z","timestamp":1615983111000},"source":"Crossref","is-referenced-by-count":4,"title":["Content of antenatal care and perception about services provided by primary hospitals in Nepal: a convergent mixed methods study"],"prefix":"10.1093","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9003-636X","authenticated-orcid":false,"given":"Yubraj","family":"Acharya","sequence":"first","affiliation":[{"name":"Department of Health Policy and Administration, The Pennsylvania State University, 601L Ford Building, University Park, PA 16802, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nigel","family":"James","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Administration, The Pennsylvania State University, 601L Ford Building, University Park, PA 16802, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rita","family":"Thapa","sequence":"additional","affiliation":[{"name":"Nick Simons Institute, Box 8975, EPC 1813, Lalitpur, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saman","family":"Naz","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Administration, The Pennsylvania State University, 601L Ford Building, University Park, PA 16802, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rishav","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Nick Simons Institute, Box 8975, EPC 1813, Lalitpur, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suresh","family":"Tamang","sequence":"additional","affiliation":[{"name":"Nick Simons Institute, Box 8975, EPC 1813, Lalitpur, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,3,17]]},"reference":[{"key":"2021040618124624300_R1","doi-asserted-by":"publisher","first-page":"2084","DOI":"10.1111\/1475-6773.12842","article-title":"Content of care in 15,000 sick child consultations in nine lower-income countries","volume":"53","author":"Kruk","year":"2018","journal-title":"Health Serv Res"},{"article-title":"2016 Nepal demographic and health survey key findings","year":"2017","author":"Ministry of Health Nepal, ICF, New ERA","key":"2021040618124624300_R2"},{"key":"2021040618124624300_R3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1371\/journal.pone.0019898","article-title":"An appraisal of the maternal mortality decline in 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