Anamika Tiwari presented a journal club on the article "Utilization of maternal health care services in post-conflict Nepal". The article used data from Nepal's Demographic and Health Survey to examine factors associated with antenatal care, institutional delivery, and postnatal care among 13,485 women in Nepal. The results found that 85% of women received antenatal care, 62% from skilled providers, and 60% started in the first trimester. Utilization of services was lower in rural areas but higher in conflict-affected areas compared to 2006. The discussion compared findings to other studies and limitations. The conclusion was that maternal health care utilization was low in rural Nepal but increased remarkably in conflict areas from 2006 to

1. Journal Club Presentation
Presented By:
Name: Anamika Tiwari
Roll No: 04
BPH, VIII Semester, SHAS, PU.
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2. Presented for the partial fulfillment of requirement
of
PHA 451 Journal Club/Health Seminar
of
Bachelor of Public Health, VIII Semester,
School of Health and Allied Sciences, Pokhara University
under the cardinal supervision of
Assistant Professor Dr. Hari Prasad Kaphle
By
Anamika Tiwari.,
Symbol no.<17370181>,
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3. Selected Article for Presentation
• Authors: Tulsi Ram Bhandari, Prabhakaran Sankara Sarma, and Vellappillil
Raman Kutty
• Tittle of article journal: Utilization of maternal health care services in
post-conflict Nepal
• Journal name: International journal of women’s health, 2015; 7: 783–790.
• DOI: 10.2147/IJWH.S90556.
• Published on: 2015 Aug 25
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4. Journal Information
• An international, peer-reviewed, open access, online journal,
publishing original research, reports, editorials, reviews and
commentaries on all aspects of women's healthcare including
gynecology, obstetrics, and breast cancer.
• History: 2009-present
• Publisher: Dove Medical Press
• Frequency: Monthly
• Impact factor: Pending (expected to be released mid 2021)
• ISSN number: 1179-1411
• Editor-in-Chief: Professor Elie D Al-Chaer
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5. Editor’s information:
Professor Elie D Al-Chaer
• Dr Elie D Al-Chaer is professor of pediatrics, internal medicine -
gastroenterology, neurobiology and developmental sciences, and the
director of the Center for Pain Research at the University of Arkansas
for Medical Sciences in the USA.
• He is also a lawyer and member of the bar in Texas and the District of
Columbia
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6. Critical Appraisal of Journal
• Good journal for publishing article related to women’s health.
• Peer-reviewed.
• Paid journal
• Easy accessibility of the articles once accepted by the journal
• Inclusion in major indexing sites.: Emerging Sources Citation Index
(ESCI),PubMed and PubMed Central ,Citation Index Expanded
(Obstetrics & Gynecology), Embase, Scopus, Directory of Open
Access Journals (DOAJ), OAIster - The Open Access Initiative.
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7. Article-Processing Charge (APC)
• Minimum initial pre payment credit of US$7500 providing 15%
discount on all submissions PLUS fast track publications.
• Minimum top up /refill of $5,000 i.e adding further payments once the
initial or current credit level runs down.
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8. Tittle of Article
• Utilization of maternal health care services in post-conflict Nepal
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9. Critical Appraisal of Tittle
• The title of the article is quite simple, clear and understandable.
• Indicated research question
• No indication of study population.
• The title does not gives the idea of study subject.
• The title reflects the aim and objective of the study.
• Complete research question is not indicated.
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10. Authors
Tulsi Ram Bhandari
• Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal
Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
• At present: associate proffesor at pokhara university.
• Publications-64, Reads - 100,223 and Citations-185
Prabhakaran Shankar Sharma
• Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal
Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
Vellappillil Raman Kutty
• Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal
Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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11. Critical Appraisal of Authors
• Total 3 authors
• Authors names are mentioned with their respective study area and
subject.
• Every authors credentials are mentioned.
• Authors were from same institution.
• Every author’s contact, email were provided.
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12. Abstract
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13. Critical Appraisal of Abstract
• Abstract is structured.
• Appropriate in its length ( 271 words i.e within the word limit of abstract in
manuscript)
• Comprehensive in its content
• Specific sections which are self-explanatory.
• Abstract gives the accurate summary of the article.
• Informative abstract ( background, methods, results, conclusion)
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14. Introduction
• In 1990, a huge people’s movement was followed by the advent of
multiparty democracy, raising popular hopes for good governance and
economic reforms.
• In 2001, the government ordered all health professionals to report to the
security officials immediately about any war injuries they had treated.
• Nepal made some extent of progress in reducing the high rate of maternal
mortality along with the improvement in other indicators during the violent
conflict period from 1996 to 2006.
• The maternal mortality ratio of Nepal was 539 in 1996, 415 in 2001, 281 in
2006, and 229 in 2011. The other indicators like antenatal care, delivery
care, and postnatal care also showed signs of improvement during the armed
conflict
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15. Critical Appraisal of Introduction
• It provides the background of the study.
• Meaningful
• It explains why the study is needed.
• It has relevant literature regarding the topic.
• All the citations are followed with correct references in the list of
references.
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16. Materials and methods
• Target population: women of reproductive age
• Study area: Nepal, all the development regions
• Study population: women who had given birth to at least one child in
the past 5 years.
• Sample size: 13,485 women
• Sampling method : Systematic random sampling
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17. • Dependent variable: maternal health care service utilization( ANC,
institutional delivery, PNC)
• Independent variables: demographic and socioeconomic variables.
• Three models for data analysis:
1st: regression analysis and maternal health service utilization
2nd: variables of development regions, ecological zones, and
residence.
3rd: socio-demographic factors including geophysical components
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18. Critical Appraisal of Materials and Methods
• Every materials and method used were properly explained.
• Sample is representative of total population.
• Questionnaire and methodology based on published report of NDHS.
• All the study variables are operationally defined, logical and measurable.
• Data taken from reliable source(NDHS,2011)
• Statistical analysis measures like chi-square tests, logistic regression.
• Dependent and independent variables mentioned.
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19. Results
1. 85% of the women who were interviewed sought at least one
antenatal care during their most recent pregnancy in the past 5 years
preceding the survey.
2. A total of 62% of the women received care from skilled providers.
3. 60% of the women started antenatal care in the first trimester and
visited health facilities four or more times for their antenatal care.
5. 40% of the women started antenatal care in the first trimester and
visited health facilities four or more times.
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20. Critical Appraisal of Results
• Results are presented in a logical and comprehensive manner.
• All the dependent and independent variables were utilized to find the
association in two different models.
• All of the results were presented in both tables and figures.
• Tables, figure and graphs are clear, understandable, numbered and titled.
• Results were clear showing the association between both variables and
objectives of the study.
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21. Discussion
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22. Continue.
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23. Critical Appraisal of Discussion
• Highlights important findings of the study.
• Discussions was made according to analyzed data.
• Comparison was logical and reasoned properly
• Authors had discussed about the limitations of the study.
• Both the dependent and independent factors which were assessed were
discussed.
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24. Conclusion
•The utilization of maternal health care services was low in rural and
remote parts of Nepal until 2011.
•There was variability in the progress patterns within and between the
development regions, ecological zones, and socioeconomic strata.
• The proportion of the utilization of maternal health care services was
remarkably high in the armed conflict areas in 2011 compared with that
of 2006.
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25. Critical Appraisal of Conclusion
• Conclusions are based on data and analysis.
• It is supported by the results drawn.
• Recommendations were based on the results of the study and are
relevant.
• The conclusion does not present new hypothesis.
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26. References
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27. Critical Appraisal of References
• There were total 50 references.
• Vancouver style of referencing.
• References are cited as per the recommended guidelines by the
journal.
• References are relevant and easily accessible through internet.
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28. Strengths
• Successfully identified the situation of utilization of maternal health care
services during the conflict in Nepal.
• Article was published and cited by various authors.
• Studies about major aspect that influences maternal health service
utilization
• Findings and discussion is based on study objective and hypothesis
• Highlights the importance of study of utilization of maternal health care
services.
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29. Weaknesses
• Inclusion and exclusion criteria was not explained.
• Recall bias could have taken place (women who gave birth to a child 5
years preceding the survey were taken)
• Ethical guidelines were not mentioned.
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30. Overall significance of the article
• Findings are believable as the methodology and data are based on
national survey (NDHS)
• Overall the article is reliable and easy to understand.
• There has been inadequate research about utilization of maternal
health services. The article helps to indentify the factors and their
association with maternal health which are appropriate and evidence
based.
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31. Contribution in conducting my research
• Title of my research: utilization of maternal health care services
during Covid pandemic in Pokhariya municipality of Parsa district.
• Sampling techniques and tools for accessing utilization rate can be
used similarly in my research.
• Findings of the articles can be compared with that of my study.
• References used in the articles can be used as guiding material for my
study.
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32. Questions?
Quarries?
Suggestions?
Feedbacks?
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33. 12/10/2020 Anamika Tiwari. 33
Thank You!