An Opportunity Not To Be Missed: Vaccination as an Entry Point for Hygiene Promotion and Diarrhoeal Disease Reduction in Nepal

This report aims to ascertain whether or not vaccination programmes offer a useful entry point for hygiene promotion and to define options for piloting and scaling up of a hygiene promotion intervention in Nepal

Elucidating the sustained decline in under‐three child linear growth faltering in Nepal, 1996-2016

Childhood linear growth faltering remains a major public health concern in Nepal. Nevertheless, over the past 20 years, Nepal sustained one of the most rapid reductions in the prevalence of stunting worldwide. First, our study analysed the trends in height-for-age z-score (HAZ), stunting prevalence, and available nutrition-sensitive and nutrition-specific determinants of linear growth faltering in under-three children across Nepal's Family Health Survey 1996 and Nepal's Demographic and Health Surveys 2001, 2006, 2001, and 2016. Second, we constructed pooled multivariable linear regression models and decomposed the contributions of our time-variant determinants on the predicted changes in HAZ and stunting over the past two decades. Our findings indicate substantial improvements in HAZ (38.5%) and reductions in stunting (-42.6%) and severe stunting prevalence (-63.9%) in Nepalese children aged 0-35 months. We also report that the increment in HAZ, across the 1996-2016 period, was significantly associated (confounder-adjustedp< .05) with household asset index, maternal and paternal years of education, maternal body mass index and height, basic child vaccinations, preceding birth interval, childbirth in a medical facility, and prenatal doctor visits. Furthermore, our quantitative decomposition of HAZ identified advances in utilisation of health care and related services (31.7% of predicted change), household wealth accumulation (25%), parental education (21.7%), and maternal nutrition (8.3%) as key drivers of the long-term and sustained progress against child linear growth deficits. Our research reiterates the multifactorial nature of chronic child undernutrition and the need for coherent multisectoral nutrition-sensitive and nutrition-specific strategies at national scale to further improve linear growth in Nepal

Sexual and reproductive health of adolescents in rural Nepal: Knowledge, attitudes and behavior

Background: Nepal has a relatively young and growing population, like most low-income countries. Recently, Nepal has accelerated its commitment to the International Conference on Population and Development (ICPD) Programme of Action by introducing a programme focusing on the sexual and reproductive health of adolescents. This paper aims to report the sexual health knowledge, attitudes and behaviour of adolescents in rural Nepal. Methods: A survey was conducted in four districts of Nepal with representative sample among adolescents aged 15–19 years using pre-tested structured questionnaire in 2011. Questionnaire contents socio-demographic questions including knowledge, attitudes and behaviours related to reproductive and sexual health. The study was approved by the Nepal Health Research Council. Results: A total 3041 adolescents (mean age 16.4 years, 49.4% male and 50.6% female) completed the questionnaire. The data indicated that HIV/AIDS and other reproductive and sexual health knowledge among the respondents was moderate. Male respondents have better knowledge on HIV/AIDS compare to female respondents. Similarly, male have better access to modern means of communications. Both male and female were equally likely to say that they had used a condom the last time they had sex. A small proportion of all respondents (9.3%) had acquired emergency contraception, two thirds of those were male (65%) and among total users of emergency contraceptives, 85% were unmarried. Conclusions: Both education and youth-friendly services, targeting to female adolescents are required to improve the sexual health status of adolescents. The findings have important implications for the (re-)development sexual health interventions for adolescents in Nepal

Birthing centres in Nepal: Recent developments, obstacles and opportunities

Background: Establishing and promoting birthing centers (BCs) can be one strategy to increase access to emergency obstetric care and skilled attendants at birth, to avert many maternal deaths. BCs are a component of local health service delivery, whereby midwives (or health care professionals with midwifery competencies) provide maternity services to generally healthy women with uncomplicated pregnancies, mostly in the community setting. Methods: A literature review was carried out involving searches and appraisals of relevant literature on birthing centers in Nepal, South Asia, and other similar settings. Findings//Conclusion: In Nepal, midwife-led care in BCs was found to be appropriate for pregnant women, with no complications, for giving birth. BCs have the potential to improve both (a) the institutional delivery rate and (b) the proportion of births that benefit from the presence of a skilled birth attendant (SBA). However, accessibility, socio-demographic characteristics, and cultural factors act as barriers to pregnant women attending birthing centres and hospital facilities. Moreover, there is an increasing trend of bypassing BCs to give birth in hospitals. The increase in facility-based births requires more monitoring of the quality of care provided

Birthing centre infrastructure in Nepal post 2015 earthquake

We suggest that a focus on improving facility delivery services starting from the most severely affected districts could be the necessary step towards achieving universal health care. Technical and financial support offered by international development partners can play a crucial role in enhancing the capabilities of health care facilities including birthing centres.</jats:p

Contribution of Nepal’s Free Delivery Care Policies in Improving Utilisation of Maternal Health Services

Background: Nepal has made remarkable improvements in maternal health outcomes. The implementation of demand and supply side strategies have often been attributed with the observed increase in utilization of maternal healthcare services. In 2005, Free Delivery Care (FDC) policy was implemented under the name of Maternity Incentive Scheme (MIS), with the intention of reducing transport costs associated with giving birth in a health facility. In 2009, MIS was expanded to include free delivery services. The new expanded programme was named “Aama” programme, and further provided a cash incentive for attending four or more antenatal visits. This article analysed the influence of FDC policies, individual and community level factors in the utilisation of four antenatal care (4 ANC) visits and institutional deliveries in Nepal. Methods: Demographic and health survey data from 1996, 2001, 2006 and 2011 were used and a multi-level analysis was employed to determine the effect of FDC policy intervention, individual and community level factors in utilisation of 4 ANC visits and institutional delivery services. Results: Multivariate analysis suggests that FDC policy had the largest effect in the utilisation of 4 ANC visits and institutional delivery compared to individual and community factors. After the implementation of MIS in 2005, women were three times (adjusted odds ratio [AOR]=3.020, P<.001) more likely to attend 4 ANC visits than when there was no FDC policy. After the implementation of Aama programme in 2009, the likelihood of attending 4 ANC visits increased six-folds (AOR=6.006, P<.001) compared prior to the implementation of FDC policy. Similarly, institutional deliveries increased two times after the implementation of the MIS (AOR=2.117, P<.001) than when there was no FDC policy. The institutional deliveries increased five-folds (AOR=5.116, P<.001) after the implementation of Aama compared to no FDC policy. Conclusion: Results from this study suggest that MIS and Aama policies have had a strong positive influence on the utilisation of 4 ANC visits and institutional deliveries in Nepal. Nevertheless, results also show that FDC policies may not be sufficient in raising demand for maternal health services withoutadequately considering the individual and community level factors

Association between obesity and miscarriage among women of reproductive age in Nepal

Background: Obesity is a major health problem in low and middle income countries (LMICs) and is associated with miscarriage. This study aims to examine the association between obesity and miscarriage among reproductive age women (15–49 years) in Nepal. Methods: The combined 19160 cross-sectional pregnancy data from the Nepal Demographic and Health Survey (NDHS) for the years 2001, 2006, 2011 and 2016 was utilized. Miscarriage was defined as a spontaneous loss of pregnancy that occurred before the foetus reached 7 months of gestational age. Logistic regression analyses that adjusted for clustering, stratification and sampling weights were used to examine the association between obesity and miscarriage among women of reproductive age. Results: The odds of miscarriage were 1.45 times higher (Adjusted odds ratio (AOR) = 1.45; 95%Cl: 1.06, 1.98, P = 0.021) among women with obesity. Women who did not use contraception, younger (15–19 years), and older women (35 years or more) were significantly more likely to have miscarriage. Women who smoked tobacco reported higher odds of miscarriage than women who did not smoke tobacco (AOR = 1.27; 95%Cl: 1.07,1.50, P = 0.006). Stratification of maternal smoking status by maternal Body Mass Index (BMI), after adjusting for contraception, mother age and year of survey revealed that tobacco smoking and obesity are associated with miscarriage (AOR = 1.46; 95%Cl: 1.05,2.04, P = 0.025). Conclusions: Findings from this study show that obesity and tobacco smoking are associated with miscarriage. Smoking cessation, pregnancy planning and counselling on healthy weight for women of reproductive age in Nepal may help promote healthy behaviours and decrease the likelihood of miscarriage