Factors affecting the choice of contraceptives among married women of reproductive age

Introduction: Family planning refers to a conscious effort by a couple to limit or space the number of children through the use of contraceptive methods. This study aims to identify the factors affecting the choice of contraceptives among married women of reproductive age. Method: A descriptive cross-sectional study design was adopted among 326 samples at Family Planning Sansthagat Clinic, Lalitpur from July to September 2017. Face-to-face interview using a structured questionnaire was used for data collection. Association between married women’s socio-demographic variables with factors affecting the choice of contraceptives were analyzed. SPSS 16 was used for statistical analysis. Ethical approval was taken from the Institutional Review Board of Tribhuvan University, Institute of Medicine. Result: The study revealed that 100% of the respondents had known about condoms and pills as contraceptives methods. 314(96.3%) of the respondents were using a modern method of family planning. Among them, 186(59.2%) were using an implant. One hundred and seventy-three women (53.1%) had started using contraceptives after the birth of their first child. 142(43.6%) stated that they discontinued using some contraceptives in the past. The main reason for discontinuation was due to side effects of 70(49.3%). Purposes of using contraceptives, preference for child sex are the significant factors for the choice of contraceptives. Conclusion:  Study result revealed that most of the respondents were using a modern method and among them, Implant was the most practiced family planning method. Women’s active involvement in decision-making regarding the use of contraceptives can play an important role in its utilization

Perceived risk, preventive behavior and enabling environment among health workers during COVID-19 pandemic in Nepal: an Online Survey

Introduction: Perceived risk, preventive behavior and enabling environment play vital role to prevent COVID-19 transmission in health care settings. The study aimed to assess perceived risk, preventive behavior and enabling environment among healthcare workers of different cadre during COVID-19 pandemic in Nepal. Methods: A cross sectional online survey was conducted among 427 health workers from April 25 to June 10, 2020. A structured questionnaire was prepared in Google form. Perceived risk was measured using 10 items scale, value ranging from 10 to 50. Descriptive and inferential statistics were computed at 5% level of significance. Ethical approval was taken from Nepal Health Research Council. Results: Of total, 49.6% respondents were male; 38.4% were from government organizations and 48.0% were doctors. Mean perceived risk was 31.8, 32.8, 31.3 among doctors, nursing professionals and others respectively; and it did not have significant difference among them. However, significant differences were observed in different items of perceived risk across difference cadre of health workers. Most of the health workers reported practice of preventive behavior always or most of the time. Of total, 5.4% doctors and 6.9% other health workers reported they had sometimes access to soap and water. 11.7% doctors, 7.5% nursing professionals and 7.8% other health workers had sometimes access to hand sanitizer; 18.0% doctors, 10.4% nursing professionals and 12.1% other health workers had sometimes access to face mask. Conclusion: Perceived risk of COVID-19 was high, preventive behavior was satisfactory; but access to enabling environment was poor. Therefore, adequate attention should be given to ensure the availability of protective equipment at work place

Adapting Small-Farm Systems to Climate Change: Preliminary Results from Participatory Community Assessments in Bajura District, Nepal

Western Nepal is a remote region that is home to a wide variety of small farm and livestock production systems. Communities here lack direct access to a suitable road infrastructure, and thus are isolated from the modern world. Farm families are often poverty stricken. Western Nepal is also enduring significant climate change, resulting in warmer and drier conditions that affect crop and livestock productivity. Our research team used Participatory Rural Appraisal (PRA) to convene the members of four small-farm communities in Bajura District, identify their priority problems and analyze how the production systems function. We then connected the prioritized problems to their sources, whether poverty or climate change, and charted a way forward that catalyzes an adaptation process to improve human welfare. Preliminary PRA results indicated that the top ranked problems across all four communities were: (1) Shortages of drinking water; (2) declining crop productivity and hence growing food insecurity; (3) the need to build capacity for people to find off-farm employment to increase incomes; and (4) the need to gain more income from livestock commercialization. Of these problems, declining crop productivity is most clearly connected to climate change because most crops are rainfall dependent. The other problems are more related to poverty, population growth, and a general lack of development investment. The PRA exercises helped formulate four Community Action Plans. These plans provide blueprints for effecting change and are the basis for future research that will document the effectiveness of interventions

Institutional delivery in public and private sectors in South Asia: a comparative analysis of prospective data from four demographic surveillance sites

BACKGROUND: Maternity care in South Asia is available in both public and private sectors. Using data from demographic surveillance sites in Bangladesh, Nepal and rural and urban India, we aimed to compare institutional delivery rates and public-private share. METHODS: We used records of maternity care collected in socio-economically disadvantaged communities between 2005 and 2011. Institutional delivery was summarized by four potential determinants: household asset index, maternal schooling, maternal age, and parity. We developed logistic regression models for private sector institutional delivery with these as independent covariates. RESULTS: The data described 52 750 deliveries. Institutional delivery proportion varied and there were differences in public-private split. In Bangladesh and urban India, the proportion of deliveries in the private sector increased with wealth, maternal education, and age. The opposite was observed in rural India and Nepal. CONCLUSIONS: The proportion of institutional delivery increased with economic status and education. The choice of sector is more complex and provision and perceived quality of public sector services is likely to play a role. Choices for safe maternity are influenced by accessibility, quantity and perceived quality of care. Along with data linkage between private and public sectors, increased regulation should be part of the development of the pluralistic healthcare systems that characterize south Asia

Institutional delivery in public and private sectors in South Asia: A comparative analysis of prospective data from four demographic surveillance sites

__Background:__ Maternity care in South Asia is available in both public and private sectors. Using data from demographic surveillance sites in Bangladesh, Nepal and rural and urban India, we aimed to compare institutional delivery rates and public-private share. __Methods:__ We used records of maternity care collected in socio-economically disadvantaged communities between 2005 and 2011. Institutional delivery was summarized by four potential determinants: household asset index, maternal schooling, maternal age, and parity. We developed logistic regression models for private sector institutional delivery with these as independent covariates. __Results:__ The data described 52 750 deliveries. Institutional delivery proportion varied and there were differences in public-private split. In Bangladesh and urban India, the proportion of deliveries in the private sector increased with wealth, maternal education, and age. The opposite was observed in rural India and Nepal. __Conclusions:__ The proportion of institutional delivery increased with economic status and education. The choice of sector is more complex and provision and perceived quality of public sector services is likely to play a role. Choices for safe maternity are influenced by accessibility, quantity and perceived quality of care. Along with data linkage between privat

Prevalence and determinants of caesarean section in private and public health facilities in underserved South Asian communities: cross-sectional analysis of data from Bangladesh, India and Nepal.

OBJECTIVES: To describe the prevalence and determinants of births by caesarean section in private and public health facilities in underserved communities in South Asia. DESIGN: Cross-sectional study. SETTING: 81 community-based geographical clusters in four locations in Bangladesh, India and Nepal (three rural, one urban). PARTICIPANTS: 45,327 births occurring in the study areas between 2005 and 2012. OUTCOME MEASURES: Proportion of caesarean section deliveries by location and type of facility; determinants of caesarean section delivery by location. RESULTS: Institutional delivery rates varied widely between settings, from 21% in rural India to 90% in urban India. The proportion of private and charitable facility births delivered by caesarean section was 73% in Bangladesh, 30% in rural Nepal, 18% in urban India and 5% in rural India. The odds of caesarean section were greater in private and charitable health facilities than in public facilities in three of four study locations, even when adjusted for pregnancy and delivery characteristics, maternal characteristics and year of delivery (Bangladesh: adjusted OR (AOR) 5.91, 95% CI 5.15 to 6.78; Nepal: AOR 2.37, 95% CI 1.62 to 3.44; urban India: AOR 1.22, 95% CI 1.09 to 1.38). We found that highly educated women were particularly likely to deliver by caesarean in private facilities in urban India (AOR 2.10; 95% CI 1.61 to 2.75) and also in rural Bangladesh (AOR 11.09, 95% CI 6.28 to 19.57). CONCLUSIONS: Our results lend support to the hypothesis that increased caesarean section rates in these South Asian countries may be driven in part by the private sector. They also suggest that preferences for caesarean delivery may be higher among highly educated women, and that individual-level and provider-level factors interact in driving caesarean rates higher. Rates of caesarean section in the private sector, and their maternal and neonatal health outcomes, require close monitoring

Cause-specific neonatal mortality: analysis of 3772 neonatal deaths in Nepal, Bangladesh, Malawi and India.

OBJECTIVE: Understanding the causes of death is key to tackling the burden of three million annual neonatal deaths. Resource-poor settings lack effective vital registration systems for births, deaths and causes of death. We set out to describe cause-specific neonatal mortality in rural areas of Malawi, Bangladesh, Nepal and rural and urban India using verbal autopsy (VA) data. DESIGN: We prospectively recorded births, neonatal deaths and stillbirths in seven population surveillance sites. VAs were carried out to ascertain cause of death. We applied descriptive epidemiological techniques and the InterVA method to characterise the burden, timing and causes of neonatal mortality at each site. RESULTS: Analysis included 3772 neonatal deaths and 3256 stillbirths. Between 63% and 82% of neonatal deaths occurred in the first week of life, and males were more likely to die than females. Prematurity, birth asphyxia and infections accounted for most neonatal deaths, but important subnational and regional differences were observed. More than one-third of deaths in urban India were attributed to asphyxia, making it the leading cause of death in this setting. CONCLUSIONS: Population-based VA methods can fill information gaps on the burden and causes of neonatal mortality in resource-poor and data-poor settings. Local data should be used to inform and monitor the implementation of interventions to improve newborn health. High rates of home births demand a particular focus on community interventions to improve hygienic delivery and essential newborn care

Prevalence and determinants of caesarean section in private and public health facilities in underserved South Asian communities: Cross-sectional analysis of data from Bangladesh, India and Nepal

Objectives: To describe the prevalence and determinants of births by caesarean section in private and public health facilities in underserved communi

Training during the COVID-19 lockdown : knowledge, beliefs, and practices of 12,526 athletes from 142 countries and six continents

OBJECTIVE Our objective was to explore the training-related knowledge, beliefs, and practices of athletes and the influence of lockdowns in response to the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS Athletes (n = 12,526, comprising 13% world class, 21% international, 36% national, 24% state, and 6% recreational) completed an online survey that was available from 17 May to 5 July 2020 and explored their training behaviors (training knowledge, beliefs/attitudes, and practices), including specific questions on their training intensity, frequency, and session duration before and during lockdown (March–June 2020). RESULTS Overall, 85% of athletes wanted to “maintain training,” and 79% disagreed with the statement that it is “okay to not train during lockdown,” with a greater prevalence for both in higher-level athletes. In total, 60% of athletes considered “coaching by correspondence (remote coaching)” to be sufficient (highest amongst world-class athletes). During lockdown, < 40% were able to maintain sport-specific training (e.g., long endurance [39%], interval training [35%], weightlifting [33%], most (83%) training for “general fitness and health maintenance” during lockdown. Athletes trained alone (80%) and focused on bodyweight (65%) and cardiovascular (59%) exercise/training during lockdown. Compared with before lockdown, most athletes reported reduced training frequency (from between five and seven sessions per week to four or fewer), shorter training sessions (from ≥ 60 to < 60 min), and lower sport-specific intensity (~ 38% reduction), irrespective of athlete classification. CONCLUSIONS COVID-19-related lockdowns saw marked reductions in athletic training specificity, intensity, frequency, and duration, with notable within-sample differences (by athlete classification). Higher classification athletes had the strongest desire to “maintain” training and the greatest opposition to “not training” during lockdowns. These higher classification athletes retained training specificity to a greater degree than others, probably because of preferential access to limited training resources. More higher classification athletes considered “coaching by correspondence” as sufficient than did lower classification athletes. These lockdown-mediated changes in training were not conducive to maintenance or progression of athletes’ physical capacities and were also likely detrimental to athletes’ mental health. These data can be used by policy makers, athletes, and their multidisciplinary teams to modulate their practice, with a degree of individualization, in the current and continued pandemic-related scenario. Furthermore, the data may drive training-related educational resources for athletes and their multidisciplinary teams. Such upskilling would provide athletes with evidence to inform their training modifications in response to germane situations (e.g., COVID related, injury, and illness).A specific funding was provided by the National Sports Institute of Malaysia for this study.The National Sports Institute of Malaysia.https://www.springer.com/journal/40279am2023Sports Medicin