Utilization of Maternal and Child Health Care Services and Nutritional Status of Under Five Children in Bungmati Village Development

Introduc on Maternal and child health care services is essen al component to promote family health. Despite of being provided free of cost, adequate u liza on of services is s ll the issue affec ng health of both mother and child in Nepal. Objec ve The objec ve of this study was to assess the u liza on of m aternal and child health care services and nutri onal status of under five children in Bungma Village Development Commi ee, Lalitpur, Nepal Methodology Descrip ve cross sec onal study was conducted in Bungma VDC of Lalitpur district, Nepal among one hundred and fi y households having either under five children, postnatal mothers or pregnant women which was selected purposively based on the objec ves of the study. Data was collected by using interview guidelines and anthropometric measurement of children under five was taken. Collected data were analyzed in SPSS. Results Regarding u liza on of maternal health care services, 90.9% had done their fourme antenatal checkup, 94.2% had delivered their baby at hospital and 65% married women of reproduc ve age were using one of the family planning methods. Likewise, immuniza on of under five children showed 100% BCG coverage, 88% pentavalent DPT and Polio, 77% Measles and low coverage of injectable Polio vaccine. About nutri onal status of under five children, more than half (57%) of the child were underweight, 41% were stunted and 20% of them were wasted. Conclusion U liza on of maternal health care services is good though coverage of family planning needs to be improved and immuniza on program should be strengthened. Awareness program for improvement of nutri onal status of the under five children should be planned to address nutri onal problem of children.


Methodology
Descrip ve cross sec onal study was conducted in Bungma VDC of Lalitpur district, Nepal among one hundred and fi y households having either under five children, postnatal mothers or pregnant women which was selected purposively based on the objec ves of the study.Data was collected by using interview guidelines and anthropometric measurement of children under five was taken.Collected data were analyzed in SPSS.

Results
Regarding u liza on of maternal health care services, 90.9% had done their four-me antenatal checkup, 94.2% had delivered their baby at hospital and 65% married women of reproduc ve age were using one of the family planning methods.Likewise, immuniza on of under five children showed 100% BCG coverage, 88% pentavalent DPT and Polio, 77% Measles and low coverage of injectable Polio vaccine.About nutri onal status of under five children, more than half (57%) of the child were underweight, 41% were stunted and 20% of them were wasted.

Conclusion
U liza on of maternal health care services is good though coverage of family planning needs to be improved and immuniza on program should be strengthened.Awareness program for improvement of nutri onal status of the under five children should be planned to address nutri onal problem of children.

INTRODUCTION
Health and well being of both mother and the children is shaped by kind of health care services that woman receives 1 during pregnancy, childbirth and post-partum period.Most of the reproduc ve age group women are dying due to 2 complica ons of pregnancy and childbirth, especially in the 3 developing countries.Similarly, 5.9 million children under the age of 5 years die annually where 45% deaths are a ributed to malnutri on. 4More than two thirds of maternal and child death occurred in South East Asia region 5 only.More than half of these early child deaths could be 4 prevented with simple and affordable interven ons.
Child and maternal mortality and morbidity rates con nue to remain high in Nepal; however, some improvements are seen in recent years.These improvement in maternal health is possible only due to improvement in health care services

RESULT
In one hundred and fi y households, there were 797 persons.Out of 797 people, 146 (18.3%) were under five children and 230 (28.8%) married women of reproduc ve age, 55 (6.9%) were mothers of under one year children.
Most (87.5%) of the households were Newars and more than three fourth (85.6%) of them were following Hindu religion.
U liza on of maternal health care services was assessed among fi y five mothers who had under one years of child.
Among them (90.1%) had gone for four me Antenatal Checkup (ANC) and all of them had got tetanus toxoid vaccine and albendazole tablet.Among them, most (94.5%) had delivered their baby at hospital whereas 5.4% had delivered at home.Around three fourth of them (74.5%) had normal delivery and one quarter (25.5%) had cesarean delivery.
(  Measles and 63% had got vaccina on against Japanese Encephali s whereas injectable polio vaccine was introduced recently so this vaccine was obtained by only 11% of under five children.(Figure 1) Examina on of nutri onal status of under-five children found that more than half (57%) were underweight, 41% stunted and 20% of them were wasted. (%)

DISCUSSION
Child and maternal mortality and morbidity rates con nue to remain high in Nepal though decline was observed from last 1 five years.Present study demonstrates u liza on of MCH services and nutri onal status of under five children.Among married women of reproduc ve age, this study revealed 65% were using one of the family planning methods, though; we did not look for the foreign employment of their husbands.It is higher than (42%) that of reported in Nepal 43% and study in a district of western Nepal showed to be 14 42%.In this study, most common method of family planning was Depoprovera (68%) followed by female steriliza on (10%) and oral pills (9%).In contrast to this, 12 NDHS 2011 found three most popular modern methods used by married women were female steriliza on (15%), injectables (9 %), and male steriliza on (8 %) and study of Jumla showed 38% male steriliza on and no female 14 steriliza on was used.This differen al results might be due to diverse geographical loca on and characteris cs among the study popula on.The results signifies awareness regarding male steriliza on should be provided in Bungama VDC to increase uptake of male steriliza on.
Moreover, our study showed that 94.5% of women of under one year age children had delivered in hospital and only 5.4% had home delivery which is approximately similar to the study conducted in eastern part of Nepal, where 80% had 15 ins tu onal delivery and 20% had home delivery.On contrary to this, in Jumla 95.8% women had given their child 14 birth at home.It reflects u liza on of ins tu onal delivery services is remarkable in our study area, this difference may be due to different geographical pa erns and facili es available in two se ngs, as our study area is in outskirts of capital city of Nepal.Likewise, more than 90% had done their four-me antenatal checkup which was assessed based on WHO recommenda on and almost all got Tetanus Toxoid injec on and Albendazole in their last pregnancy among our study par cipants which is similar with the findings of study 15 of eastern part of Nepal.In contrast to this, one third of 13 women did not go for ANC in Jumla.This difference might be due to accessibility of services due to geographical terrain though MCH services are provided free of cost from Government of Nepal.
In determining child health status, immuniza on plays crucial roles.Our study found that almost all under five child got BCG vaccina on followed by 88% DPT and Polio and 71% measles which is similar in case of BCG and lower for other vaccines 13 than the Na onal coverage.Injectable polio was recently included in Na onal Immuniza on schedule so it might be the reason of low coverage.
The nutri onal status of under-five children is an important measure of children's health.Adequate nutri on is cri cal to study conducted in Chitwan.This differen al nutri onal status of under five children may be due to different determinants which was not the scope of present study.This study was cross sec onal study conducted in one VDC with limited sample size so causal rela onship could not be established.

CONCLUSION
MCH services are crucial in determining the health of mother and children.This study reflected, though, u liza on MCH services was sa sfactory, nutri onal status of under five children was not good.We should try to increase the coverage of services to make it cent percent.All those pregnant mothers not a ending the ANC clinic for four mes as per government schedule and delivering baby at home, need to be iden fied.The underlying factor for under u liza on of the service should be iden fied.

RECOMMENDATION
There is need of further explora ve analy cal study to iden fy the determinants of not u liza on of MCH services.
Interven on targeted to reduce the nutri onal problems of under five children is recommended to address the iden fied nutri onal problem of under five children.

1 provided
to the women.In Nepal, under five children face mul ple obstacles such as infec ons, malnutri on for survival and development, along with the poor maternal 6,7 nutri onal status during pregnancy.Access to family planning contributes to Maternal and Child Health (MCH) by preven ng unintended pregnancies and poor obstetrical 8 outcomes.Maternal mortality in developing countries could be dropped by more than 20% if the current demand 9 for family planning services were met.U liza on of MCH care services is related to the decision making power and autonomy of the women about her own health problems 10 and spousal communica on.Underu liza on of MCH services is one of the important contribu ng factor to high maternal mortality and child mortality especially in context of developing countries like Nepal where most of the 11 deliveries takes place at home.Therefore, this study assessed the u liza on of MCH services and nutri onal status of under five children in Bungama VDC, Nepal.METHODOLOGY Descrip ve Cross-sec onal study was conducted from February to June 2015 in six wards (1-6) of Bungma VDC in one hundred and fi y households.Households having either under five children, postnatal mothers or pregnant women were selected purposively based on the objec ves of the study.Data was collected by direct interview and observa on method using structured ques onnaire.Weight of the children was measured using mechanical weighing machine and height was measured using clinical measuring tape.Informed consent was taken from the respondents before collec ng the data.Data was entered in Microso Excel and analysis was done by using SPSS 20 version.Descrip ve sta s cs (frequency and percentage) were used for analysis.