Maternal Health Care Service Access to Disabled and Dalit Women in Nepal

BACKGROUND: The access and utilization of maternal health care services by disabled and Dalit women in Nepal has not been well studied, and yet disparities in these may result in poor health outcomes. Co-existence of caste and disability may lead Dalit women with disability to further exclusion and marginalization, preventing them to access basic human rights and opportunities such as maternal health care services. It is therefore important to understand disabled and Dalit women’s access and utilization of health care service and the effect of intersectionality between their caste status and disability in the use of services. Previous efforts have focused on disability, gender and caste separately, but few studies have attempted to understand the inter-relationship between them or where they co-exist. This study explored this complex relationship and the multiple perspectives of Dalit women with and without disability about their access and utilization of maternal health care services with the assumption that all of these factors interacting together lead to exclusion and marginalization preventing their access and utilization of services. The study objectives were: (i) to compare and determine maternal health care service access and utilization patterns among disabled and non-disabled, Dalit and non-Dalit women in the Rupandehi district; (ii) to understand the attitude and behaviours of society and maternal health care providers towards disability; and (iii) to identify inhibiting and enabling factors for disabled and Dalit women with regards to access and utilization of maternal health care service. METHODS: The study employed a mixed methods design combining quantitative and qualitative components of data collection and analysis. Quantitative data was obtained from survey questionnaires administered to women between aged 15 - 49 years and also of their health care providers. A total 354 women, of which 79 were disabled (18 disabled Dalit and 61 disabled non-Dalit) and 275 non-disabled (133 non-disabled Dalit and 142 non-disabled non-Dalit) participated in the survey. While qualitative data was gathered from 37 in-depth interviews, six focus group discussions with women (disabled and non-disabled; Dalit and non-Dalit), and six key informant interviews with activists, community leaders and policy makers. Quantitative data was analysed using descriptive statistics, bivariate and multivariate analysis with a logistic regression model and theme content analysis was applied to the qualitative data. RESULTS: The study found inequitable utilization of maternal health care services, with disabled women having lower utilization of ANC one (83.5% vs 96.7%, P0.05). Rather it found that maternal health care services are not easily or equitably accessible to all social groups, preventing full utilization for disabled. Societal and health care providers’ attitudes towards disability were often found to be negative, although there were positive and negative user experiences and perceptions of provider’s attitude and behaviours. A further finding of the study was that the health care needs of disabled women are invisible at the policy level, which appeared to translate into unsuitable health care settings and ill-prepared health care providers to cater for them. Women from all social groups encountered a number of barriers to access, relating to personal, socio-cultural, and policy or system factors; however, disabled women faced additional barriers. Women with disabilities from all social groups faced physical, attitudinal, socio-cultural and policy related issues, including a lack of knowledge and skills among providers were critical barriers for women with disabilities; whereas having positive providers, a favourable family environment, as well as education and information, were enabling factors for disabled women’s access and utilization of care. Women with disabilities from all social groups also have higher levels of fear and perceived risks associated with pregnancy and delivery. This is primarily linked to worries about delivery complications associated with their disability and also that the baby would inherit their disability. The study did not find any compounding effect of caste and disability in access and utilization of maternal health care services. CONCLUSION: Improving equity and maternal health care access and utilization for disabled and other marginalised women requires that policy and existing traditional strategies be re-examined, re-developed and implemented through a human rights-based lens, with programme interventions focused on addressing persistent negative attitudes and socio-cultural barriers. Women’s education, social status, decision-making power and access to resources are critical factors associated with health care access and utilization among all groups of women. Significantly, women with disabilities, no matter what their social group, faced greater barriers than non-disabled women. Therefore, in order to increase access and utilization of maternal health care services across the population, holistic approaches including multi-sectoral interventions should be adopted

Disability, Caste, and Intersectionality: Does Co-Existence of Disability and Caste Compound Marginalization for Women Seeking Maternal Healthcare in Southern Nepal?

Background: Disability and caste are two different forms of oppression; however, people of the Dalit caste in Nepal and people with disabilities commonly face similar types of marginalities. Dalit women with disabilities may experience double discrimination because of the intersectionality of disability and caste. This study examines whether the disability and caste identity of women together affects and compounds the utilization of maternal healthcare services. Methods: A cross-sectional survey was conducted using a semi-structured questionnaire among a total of 354 Dalit and non-Dalit women, with and without a disability aged between 15–49 years. Maternal healthcare service utilization was assessed by antenatal care (ANC), health facility (HF) delivery, and postnatal care (PNC) during the last pregnancy. Logistic regression was performed to detect the predictors of service utilization and identify whether disability and caste were associated with service utilization. First, disability and caste were fitted separately in models. Secondly, the intersectionality of disability and caste was tested by inclusion of a disability*caste interaction term. Finally, the confounding effect of socio-demographic factors was investigated. Results: Out of surveyed women, 73% had 4+ ANC visits, 65% had HF delivery, and 29% had a PNC visit during their last pregnancy. Women with a disability had lower odds of HF delivery (OR 0.50, CI 0.30–0.84) and PNC (OR 0.47, CI 0.25–0.88) than women without a disability. Adjustment for women’s age and household wealth explained associations in HF delivery by women with disabilities. There was no association between caste and service utilization. Disability overrode caste, and there was no other evidence of effect modification by women’s caste status in the utilization. However, a weak interaction effect in the utilization of ANC services was found in the caste group by their education (OR 0.19, 95% CI 0.05–0.74). Conclusions: Disabled women—whether Dalit or non-Dalit—had lower rates of utilizing all maternal healthcare services than non-disabled women. Interestingly, Dalit women with disabilities were more likely to receive PNC than non-Dalit women with disabilities. Increasing equity in maternal healthcare service utilization requires that traditional approaches to service development and program intervention be re-examined and more nuanced interventions considered to ensure improved access and outcomes among all vulnerable groups

Societal attitude and behaviours towards women with disabilities in rural Nepal: pregnancy, childbirth and motherhood

BACKGROUND: This study reviews the attitudes and behaviours in rural Nepalese society towards women with disabilities, their pregnancy, childbirth and motherhood. Society often perceives people with disabilities as different from the norm, and women with disabilities are frequently considered to be doubly discriminated against. Studies show that negative perceptions held in many societies undervalue women with disabilities and that there is discomfort with questions of their control over pregnancy, childbirth and motherhood, thus limiting their sexual and reproductive rights. Public attitudes towards women with disabilities have a significant impact on their life experiences, opportunities and help-seeking behaviours. Numerous studies in the global literature concentrate on attitudes towards persons with disabilities, however there have been few studies in Nepal and fewer still specifically on women. METHODS: A qualitative approach, with six focus group discussions among Dalit and non-Dalit women without disabilities and female community health volunteers on their views and understandings about sexual and reproductive health among women with disabilities, and 17 face-to-face semi-structured interviews with women with physical and sensory disabilities who have had the experience of pregnancy and childbirth was conducted in Rupandehi district in 2015. Interviews were audio-recorded, transcribed, and translated into English before being analysed thematically. RESULTS: The study found negative societal attitudes with misconceptions about disability based on negative stereotyping and a prejudiced social environment. Issues around the marriage of women with disabilities, their ability to conceive, give birth and safely raise a child were prime concerns identified by the non-disabled study participants. Moreover, many participants with and without disabilities reported anxieties and fears that a disabled woman’s impairment, no matter what type of impairment, would be transmitted to her baby, Participants – both disabled and non-disabled, reported that pregnancy and childbirth of women with disabilities were often viewed as an additional burden for the family and society. Insufficient public knowledge about disability leading to inaccurate blanket assumptions resulted in discrimination, rejection, exclusion and violence against women with disabilities inside and outside their homes. Stigma, stereotyping and prejudice among non-disabled people resulted to exclusion, discrimination and rejection of women with disabilities. Myths, folklore and misconceptions in culture, tradition and religion about disability were found to be deeply rooted and often cited as the basis for individual beliefs and attitudes. CONCLUSION: Women with disabilities face significant challenges from family and society in every sphere of their reproductive lives including pregnancy, childbirth and motherhood. There is a need for social policy to raise public awareness and for improved advocacy to mitigate misconception about disability and promote disabled women’s sexual and reproductive rights

Application of frequency ratio, statistical index, and weights-of-evidence models and their comparison in landslide susceptibility mapping in Central Nepal Himalaya

The Mugling–Narayanghat road section falls within the Lesser Himalaya and Siwalik zones of Central Nepal Himalaya and is highly deformed by the presence of numerous faults and folds. Over the years, this road section and its surrounding area have experienced repeated landslide activities. For that reason, landslide susceptibility zonation is essential for roadside slope disaster management and for planning further development activities. The main goal of this study was to investigate the application of the frequency ratio (FR), statistical index (SI), and weights-of-evidence (WoE) approaches for landslide susceptibility mapping of this road section and its surrounding area. For this purpose, the input layers of the landslide conditioning factors were prepared in the first stage. A landslide inventory map was prepared using earlier reports, aerial photographs interpretation, and multiple field surveys. A total of 438 landslide locations were detected. Out these, 295 (67 %) landslides were randomly selected as training data for the modeling using FR, SI, and WoE models and the remaining 143 (33 %) were used for the validation purposes. The landslide conditioning factors considered for the study area are slope gradient, slope aspect, plan curvature, altitude, stream power index, topographic wetness index, lithology, land use, distance from faults, distance from rivers, and distance from highway. The results were validated using area under the curve (AUC) analysis. From the analysis, it is seen that the FR model with a success rate of 76.8 % and predictive accuracy of 75.4 % performs better than WoE (success rate, 75.6 %; predictive accuracy, 74.9 %) and SI (success rate, 75.5 %; predictive accuracy, 74.6 %) models. Overall, all the models showed almost similar results. The resultant susceptibility maps can be useful for general land use planning

The role of diet in the aetiopathogenesis of inflammatory bowel disease

Crohn’s disease and ulcerative colitis, collectively known as IBD, are chronic inflammatory disorders of the gastrointestinal tract. Although the aetiopathogenesis of IBD is largely unknown, it is widely thought that diet has a crucial role in the development and progression of IBD. Indeed, epidemiological and genetic association studies have identified a number of promising dietary and genetic risk factors for IBD. These preliminary studies have led to major interest in investigating the complex interaction between diet, host genetics, the gut microbiota and immune function in the pathogenesis of IBD. In this Review, we discuss the recent epidemiological, gene–environment interaction, microbiome and animal studies that have explored the relationship between diet and the risk of IBD. In addition, we highlight the limitations of these prior studies, in part by explaining their contradictory findings, and review future directions

Landslide susceptibility mapping using support vector machine and GIS at the Golestan province, Iran

The main goal of this study is to produce landslide susceptibility map using GIS-based support vector machine (SVM) at Kalaleh Township area of the Golestan province, Iran. In this paper, six different types of kernel classifiers such as linear, polynomial degree of 2, polynomial degree of 3, polynomial degree of 4, radial basis function (RBF) and sigmoid were used for landslide susceptibility mapping. At the first stage of the study, landslide locations were identified by aerial photographs and field surveys, and a total of 82 landslide locations were extracted from various sources. Of this, 75% of the landslides (61 landslide locations) are used as training dataset and the rest was used as (21 landslide locations) the validation dataset. Fourteen input data layers were employed as landslide conditioning factors in the landslide susceptibility modelling. These factors are slope degree, slope aspect, altitude, plan curvature, profile curvature, tangential curvature, surface area ratio (SAR), lithology, land use, distance from faults, distance from rivers, distance from roads, topographic wetness index (TWI) and stream power index (SPI). Using these conditioning factors, landslide susceptibility indices were calculated using support vector machine by employing six types of kernel function classifiers. Subsequently, the results were plotted in ArcGIS and six landslide susceptibility maps were produced. Then, using the success rate and the prediction rate methods, the validation process was performed by comparing the existing landslide data with the six landslide susceptibility maps. The validation results showed that success rates for six types of kernel models varied from 79% to 87%. Similarly, results of prediction rates showed that RBF (85%) and polynomial degree of 3 (83%) models performed slightly better than other types of kernel (polynomial degree of 2 = 78%, sigmoid = 78%, polynomial degree of 4 = 78%, and linear = 77%) models. Based on our results, the differences in the rates (success and prediction) of the six models are not really significant. So, the produced susceptibility maps will be useful for general land-use planning

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)1.

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field

An index to describe the earthquake effect on subsequent landslides in Central Taiwan

[[abstract]]Chelungpu fault reactivation produced the 1999 Chi-Chi earthquake in Central Taiwan in 1999, triggering many landslides over a broad area. The ground damage caused by the Chi-Chi earthquake still influences successive rainfall-triggered landslides. The landslide distribution triggered by heavy rainfall during typhoon Mindulle in 2004 has a high correlation to the landslide sites triggered by the previous Chi-Chi earthquake. This research calculated and ordered landslide data for both the area and distance from the Chelungpu fault. The rank correlation coefficient for measuring two covarying variables is employed to quantify the degree of correlation between the landslide distribution and the Chelungpu fault. A high rank correlation coefficient value demonstrates a highly correlated relationship between the subsequent landslides in 2004 and previous Chelungpu fault activity in 1999.[[notice]]補正完