Women's health groups to improve perinatal care in rural Nepal

BACKGROUND: Neonatal mortality rates are high in rural Nepal where more than 90% of deliveries are in the home. Evidence suggests that death rates can be reduced by interventions at community level. We describe an intervention which aimed to harness the power of community planning and decision making to improve maternal and newborn care in rural Nepal. METHODS: The development of 111 women's groups in a population of 86 704 in Makwanpur district, Nepal is described. The groups, facilitated by local women, were the intervention component of a randomized controlled trial to reduce perinatal and neonatal mortality rates. Through participant observation and analysis of reports, we describe the implementation of this intervention: the community entry process, the facilitation of monthly meetings through a participatory action cycle of problem identification, community planning, and implementation and evaluation of strategies to tackle the identified problems. RESULTS: In response to the needs of the group, participatory health education was added to the intervention and the women's groups developed varied strategies to tackle problems of maternal and newborn care: establishing mother and child health funds, producing clean home delivery kits and operating stretcher schemes. Close linkages with community leaders and community health workers improved strategy implementation. There were also indications of positive effects on group members and health services, and most groups remained active after 30 months. CONCLUSION: A large scale and potentially sustainable participatory intervention with women's groups, which focused on pregnancy, childbirth and the newborn period, resulted in innovative strategies identified by local communities to tackle perinatal care problems

Living knowledge of the healing plants: Ethno-phytotherapy in the Chepang communities from the Mid-Hills of Nepal

Contribution of indigenous knowledge in developing more effective drugs with minimum or no side effects helped to realise importance of study of indigenous remedies and the conservation of biological resources. This study analysed indigenous knowledge regarding medicinal plants use among the Chepang communities from ward number 3 and 4 of Shaktikhor Village Development Committee located in the central mid hills of Nepal. Data were collected in a one-year period and included interviews with traditional healers and elders. Chepangs are rich in knowledge regarding use of different plants and were using a total 219 plant parts from 115 species including one mushroom (belonging 55 families) for medicinal uses. Out of these, 75 species had 118 different new medicinal uses and 18 of them were not reported in any previous documents from Nepal as medicinal plants. Spiritual belief, economy and limitation of alternative health facilities were cause of continuity of people's dependency on traditional healers. Change in socio-economic activities not only threatened traditional knowledge but also resource base of the area. Enforcement of local institution in management of forest resources and legitimating traditional knowledge and practices could help to preserve indigenous knowledge

Indigenous and Scientific Knowledge of Soil Regulation Services, and Factors Effecting Decision-Making in Agricultural Landscapes in the Terai Plains of Nepal

Rapid degradation of soil regulation services is a growing concern for agricultural producers worldwide, with the potential for adverse impacts on agricultural productivity, food security, and livelihoods. Yet, data integrating observations of soil nutrient and physical status with farmers’ knowledge of soil fertility is lacking, while landscape-level empirical assessments remain limited. In this paper, it is argued that a deeper understanding of the benefits and trade-offs of management practices currently employed by farmers to secure soil nutrients could help to promote improvements in natural resource management, agricultural productivity and efficiency. Using the case of the Central and Western Terai Plains of Nepal in 2012–2014, rice-cultivated soil parameters were estimated, and 354 respondents were interviewed to determine the cropping systems, soil nutrient status and risks, indigenous soil classification systems, and key biophysical, institutional, economic and risk perception factors effecting decision-making. Findings reveal farmers are acutely aware of the main causes of soil degradation and until today, these issues continue to be of critical importance. To counter this degradation, farmers employ a diversity of landscape-level practices to secure optimal crop yields and soil nutrients. However, farmers have limited access to agricultural extension services and scientific monitoring and apply fewer mineral fertilisers than previously reported. Additional investments are required to optimize farmers’ practices and soil regulation services, such as cooperation for knowledge innovation systems, public/private extension, organisation for co-management, integrated nutrient management, and private forestry on farms. The case illustrates local knowledge and incremental efforts to adapt to emerging risks remain the foundation to implement spatially targeted conservation measures and design adaptive land use plans

Community perceptions of unintentional child injuries in Makwanpur district of Nepal: A qualitative study

Background: In Nepal, childhood unintentional injury is an emerging public health problem but it has not been prioritised on national health agenda. There is lack of literature on community perceptions about child injuries. This study has explored community perceptions about child injuries and how injuries can be prevented. Methods. Focus group discussions were conducted with mothers, school students and community health volunteers from urban and rural parts of Makwanpur district in Nepal. FGDs were conducted in Nepali languages. These were recorded, transcribed and translated into English. A theoretical framework was identified and thematic analysis conducted. Results: Three focus group discussions, with a total of 27 participants, took place. Participants were able to identify examples of child injuries which took place in their community but these generally related to fatal and severe injuries. Participants identified risk factors such as the child's age, gender, behaviours and whether they had been supervised. Consequences of injuries such as physical and psychological effects, impact on household budgets and disturbance in household plans were identified. Suggestions were made about culturally appropriate prevention measures, and included; suitable supervision arrangements, separation of hazards and teaching about safety to the parents and children. Conclusion: Community members in Nepal can provide useful information about childhood injuries and their prevention but this knowledge is not transferred into action. Understanding community perceptions about injuries and their prevention can contribute to the development of preventive interventions in low income settings. © 2014 Pant et al.; licensee BioMed Central Ltd

Social Change and the Relationships Between Education and Employment

Social change, Employment, Education, Nepal,

Environmental change and out-migration: evidence from Nepal

Scholars and activists have hypothesized a connection between environmental change and out-migration. In this paper we test this hypothesis using data from Nepal. We operationalize environmental change in terms of declining land cover, rising times required to gather organic inputs, increasing population density, and perceived declines in agricultural productivity. In general, environmental change is more strongly related to short- than long-distance moves. Holding constant the effects of other social and economic variables, we find that local moves are predicted by perceived declines in productivity, declining land cover, and increasing time required to gather firewood. Long-distance moves are predicted by perceived declines in productivity, but the effect is weaker than in the model of short-distance mobility. We also show that effects of environmental change vary by gender and ethnicity, with women being more affected by changes in the time required to gather fodder and men by changes in the time to gather firewood, and high caste Hindus generally being less affect than others by environmental change