Factors that promote or hinder maternal health service provision by female community health volunteers in rural Nepal

Female Community Health Volunteers (FCHVs) provide basic Maternal Health Services (MHSs) to pregnant women and mothers in their communities. Their contribution to maternal health has been praised, as Nepal managed to reduce its maternal mortality by more than two-thirds and met the Millennium Development Goal 5. However, little published evidence is available on FCHVs’ views and the factors that promote or hinder their services. This thesis explores the role of FCHVs in MHS provision in two regions (the hill and Terai ) of Nepal, from the perspectives of health workers, service users, and FCHVs themselves. A qualitative approach was adopted using semi-structured interviews, focus group discussions (FGDs) and field notes. Interviews were conducted with 20 FCHVs, 11 health workers and 26 women in villages from the two study regions. In addition, four FGDs were held with 19 FCHVs and field notes were taken throughout the data collection. Data were analysed using thematic analysis. Findings indicate that FCHVs play an important role in MHS provision in the hill villages where there is limited access to professional healthcare. The FCHVs detected pregnancies, referred them for health check-ups, accompanied them for deliveries and assisted in child-births. They also distributed medicines and informed women on the availability of safe abortion services. In both regions, the FCHVs raised health awareness among pregnant women/mothers casually or through organised meetings. In the hill villages, they used interesting casual approaches to share maternal health information, for example, singing folk songs with health messages in them or visiting new mothers with nutritious food hampers. Such services were beneficial to the women in the remote villages, who otherwise would not have received any healthcare. The FCHVs also shared maternal health messages through regularly organised mothers' group meetings. Unfortunately, these meetings were also used for monetary discussions, which left a little time for discussion on health topics. Such activity combined with the lack of FCHVs’ education often proved to be counterproductive on their service provision. They have a desire to volunteer, as they saw their service as social responsibility, felt empowered and enjoyed community recognition. However, a lack of financial and non-financial incentives was the key hindrance for them followed by perceived community misconceptions regarding their voluntary status. The FCHVs’ illiteracy and older age also affected their services. Finally, various health systems related factors also hindered their services: a lack of access to medical supplies, inadequate training and supervision. In general, volunteers in the terai region were less supported than those in the hill region. In addition, a perceived lack of respect by some health workers towards volunteers and a lack of coordination between government health centres and NGOs were noted. Overall, the study found that most interviewees perceived FCHVs as a valuable resource in improving the maternal health of the poor women. In some remote hill villages, they are the only MHS providers. Therefore, their contribution to MHS needs to be recognised and respected by both the health workers and the communities. It is important that FCHVs are provided with context specific support - incentives, access to supplies and supportive supervision - to enable them to deliver services more productively and to ensure that these services flourish in the future

Feature weighting as a tool for unsupervised feature selection

Feature selection is a popular data pre-processing step. The aim is to remove some of the features in a data set with minimum information loss, leading to a number of benefits including faster running time and easier data visualisation. In this paper we introduce two unsupervised feature selection algorithms. These make use of a cluster-dependent feature-weighting mechanism reflecting the within-cluster degree of relevance of a given feature. Those features with a relatively low weight are removed from the data set. We compare our algorithms to two other popular alternatives using a number of experiments on both synthetic and real-world data sets, with and without added noisy features. These experiments demonstrate our algorithms clearly outperform the alternatives

A spatially distributed hydroeconomic model to assess the effects of drought on land use, farm profits, and agricultural employment.

In this paper a high-resolution linked hydroeconomic model is demonstrated for drought conditions in a Brazilian river basin.Doi: 10.1029/2008WR00753

Practice changes beta power at rest and its modulation during movement in healthy subjects but not in patients with Parkinson\u27s disease

Abstract Background PD (Parkinson\u27s disease) is characterized by impairments in cortical plasticity, in beta frequency at rest and in beta power modulation during movement (i.e., event‐related ERS [synchronization] and ERD [desynchronization]). Recent results with experimental protocols inducing long‐term potentiation in healthy subjects suggest that cortical plasticity phenomena might be reflected by changes of beta power recorded with EEG during rest. Here, we determined whether motor practice produces changes in beta power at rest and during movements in both healthy subjects and patients with PD. We hypothesized that such changes would be reduced in PD. Methods We thus recorded EEG in patients with PD and age‐matched controls before, during and after a 40‐minute reaching task. We determined posttask changes of beta power at rest and assessed the progressive changes of beta ERD and ERS during the task over frontal and sensorimotor regions. Results We found that beta ERS and ERD changed significantly with practice in controls but not in PD. In PD compared to controls, beta power at rest was greater over frontal sensors but posttask changes, like those during movements, were far less evident. In both groups, kinematic characteristics improved with practice; however, there was no correlation between such improvements and the changes in beta power. Conclusions We conclude that prolonged practice in a motor task produces use‐dependent modifications that are reflected in changes of beta power at rest and during movement. In PD, such changes are significantly reduced; such a reduction might represent, at least partially, impairment of cortical plasticity

Participatory policy analysis in health policy and systems research: reflections from a study in Nepal.

Background Participatory policy analysis (PPA) as a method in health policy and system research remains underexplored. Using our experiences of conducting PPA workshops in Nepal to explore the impact of the country’s move to federalism on its health system, we reflect on the method’s strengths and challenges. We provide an account of the study context, the design and implementation of the workshops, and our reflections on the approach’s strengths and challenges. Findings on the impact of federalism on the health system are beyond the scope of this manuscript. Main body We conducted PPA workshops with a wide range of health system stakeholders (political, administrative and service-level workforce) at the local and provincial levels in Nepal. The workshops consisted of three activities: river of life, brainstorming and prioritization, and problem-tree analysis. Our experiences show that PPA workshops can be a valuable approach to explore health policy and system issues – especially in a context of widespread systemic change which impacts all stakeholders within the health system. Effective engagement of stakeholders and activities that encourage both individual- and system-level reflections and discussions not only help in generating rich qualitative data, but can also address gaps in participants’ understanding of practical, technical and political aspects of the health system, aid policy dissemination of research findings, and assist in identifying short- and long-term practice and policy issues that need to be addressed for better health system performance and outcomes. Conducting PPA workshops is, however, challenging for a number of reasons, including the influence of gatekeepers and power dynamics between stakeholders/participants. The role and skills of researchers/facilitators in navigating such challenges are vital for success. Although the long-term impact of such workshops needs further research, our study shows the usefulness of PPA workshops for researchers, for participants and for the wider health system. Conclusions PPA workshops can effectively generate and synthesize health policy and system evidence through collaborative engagement of health system stakeholders with varied roles. When designed with careful consideration for context and stakeholders’ needs, it has great potential as a method in health policy and systems research

Observation and analysis of spatiotemporal characteristics of surface ozone and carbon monoxide at multiple sites in the Kathmandu Valley, Nepal

Residents of the Kathmandu Valley experience severe particulate and gaseous air pollution throughout most of the year, even during much of the rainy season. The knowledge base for understanding the air pollution in the Kathmandu Valley was previously very limited but is improving rapidly due to several field measurement studies conducted in the last few years. Thus far, most analyses of observations in the Kathmandu Valley have been limited to short periods of time at single locations. This study extends the past studies by examining the spatial and temporal characteristics of two important gaseous air pollutants (CO and O3) based on simultaneous observations over a longer period at five locations within the valley and on its rim, including a supersite (at Bode in the valley center, 1345&thinsp;m above sea level) and four satellite sites: Paknajol (1380&thinsp;m&thinsp;a.s.l.) in the Kathmandu city center; Bhimdhunga (1522&thinsp;m&thinsp;a.s.l.), a mountain pass on the valley's western rim; Nagarkot (1901&thinsp;m&thinsp;a.s.l.), another mountain pass on the eastern rim; and Naikhandi (1233&thinsp;m&thinsp;a.s.l.), near the valley's only river outlet. CO and O3 mixing ratios were monitored from January to July 2013, along with other gases and aerosol particles by instruments deployed at the Bode supersite during the international air pollution measurement campaign SusKat-ABC (Sustainable Atmosphere for the Kathmandu Valley – endorsed by the Atmospheric Brown Clouds program of UNEP). The monitoring of O3 at Bode, Paknajol and Nagarkot as well as the CO monitoring at Bode were extended until March 2014 to investigate their variability over a complete annual cycle. Higher CO mixing ratios were found at Bode than at the outskirt sites (Bhimdhunga, Naikhandi and Nagarkot), and all sites except Nagarkot showed distinct diurnal cycles of CO mixing ratio, with morning peaks and daytime lows. Seasonally, CO was higher during premonsoon (March–May) season and winter (December–February) season than during monsoon season (June–September) and postmonsoon (October–November) season. This is primarily due to the emissions from brick industries, which are only operational during this period (January–April), as well as increased domestic heating during winter, and regional forest fires and agro-residue burning during the premonsoon season. It was lower during the monsoon due to rainfall, which reduces open burning activities within the valley and in the surrounding regions and thus reduces sources of CO. The meteorology of the valley also played a key role in determining the CO mixing ratios. The wind is calm and easterly in the shallow mixing layer, with a mixing layer height (MLH) of about 250&thinsp;m, during the night and early morning. The MLH slowly increases after sunrise and decreases in the afternoon. As a result, the westerly wind becomes active and reduces the mixing ratio during the daytime. Furthermore, there was evidence of an increase in the O3 mixing ratios in the Kathmandu Valley as a result of emissions in the Indo-Gangetic Plain (IGP) region, particularly from biomass burning including agro-residue burning. A top-down estimate of the CO emission flux was made by using the CO mixing ratio and mixing layer height measured at Bode. The estimated annual CO flux at Bode was 4.9&thinsp;µg&thinsp;m−2&thinsp;s−1, which is 2–14 times higher than that in widely used emission inventory databases (EDGAR HTAP, REAS and INTEX-B). This difference in CO flux between Bode and other emission databases likely arises from large uncertainties in both the top-down and bottom-up approaches to estimating the emission flux. The O3 mixing ratio was found to be highest during the premonsoon season at all sites, while the timing of the seasonal minimum varied across the sites. The daily maximum 8&thinsp;h average O3 exceeded the WHO recommended guideline of 50&thinsp;ppb on more days at the hilltop station of Nagarkot (159 out of 357 days) than at the urban valley bottom sites of Paknajol (132 out of 354 days) and Bode (102 out of 353 days), presumably due to the influence of free-tropospheric air at the high-altitude site (as also indicated by Putero et al., 2015, for the Paknajol site in the Kathmandu Valley) as well as to titration of O3 by fresh NOx emissions near the urban sites. More than 78&thinsp;% of the exceedance days were during the premonsoon period at all sites. The high O3 mixing ratio observed during the premonsoon period  is of a concern for human health and ecosystems, including agroecosystems in the Kathmandu Valley and surrounding regions.</p

The COVID-19 pandemic in Nepal: Emerging evidence on the effectiveness of action by, and cooperation between, different levels of government in a federal system

A new coronavirus disease (COVID-19) caused by a novel pathogen (SARS-CoV-2) spread rapidly around the world in the early months of 2020, and was declared a pandemic by the World Health Organization (WHO) on 11 March. COVID-19 has, and continues to have, large implications for individuals, societies, and for national health systems across the globe. Due to its novelty and impact, it has challenged all health care systems where the virus has taken hold. The ways in which governments and health systems have responded have varied widely across the world. In the case of Nepal, the pandemic represented a major test for the newly decentralised health system, created as a result of the implementation of the 2015 federal constitution. This paper, which forms a part of our large on-going study of the decentralisation of the health system in the country, presents some of the early evidence on the effectiveness of the actions taken by Federal, Provincial and Local Governments and the levels of cooperation and coordination between them

Polar opposites? NGOs, left parties and the fight for social change in Nepal

In the early 1990s, when NGOs were rising to prominence as an ostensible force for social change in Nepal, the Maoists were also beginning to organise, and denounced NGOs as agents of imperialism. The Maoists came to prominence by fighting a People’s War launched in 1996, with the intention of improving life for the poor peasant and working-class majority. But after a decade-long struggle, the Maoists became incorporated into the parliamentary system. While Nepal’s first democratic revolution in 1990 met formal, popular political demands, which were consolidated in a subsequent revolution in 2006 overthrowing the monarchy and bringing the People’s War to an end, there was little socio-economic progress for the vast majority. The argument advanced in this article is that this lack of progress relied on the interplay of two phenomena: an anti-Maoist alliance consisting of the international community, the domestic ruling elite and NGOs, and a fundamental ambiguity at the heart of the Maoists’ political theory