Prevalence of Postpartum Family Planning Service Coverage in Selected Referral Facilities of Nepal

Introduction: Nepal Society of Obstetricians and Gynecologists jointly with the Nepalese government and with the support from the International Federation of Obstetrics and Gynecology has implemented an initiative to institutionalize postpartum family planning services in selected major referral facilities of Nepal to address the gap of low uptake of postpartum family planning in Nepal. The aim of the study is to find the prevalence of the service coverage of postpartum contraception in the selected facilities. Methods: A descriptive cross-sectional study was conducted in seven major referral facilities across Nepal. Data were collected from the hospital records of all women who delivered in these facilities between October 2018 and March 2019. Ethical approval for this study was obtained from Nepal Health Research Council. Data analysis was done with SPSS version 23. Results: Among the 29,072 deliveries from all the facilities, postpartum family planning counseling coverage was 27,301 (93.9%). The prevalence of uptake of Postpartum Intrauterine Device is 1581 (5.4%) and female sterilization is 1830 (6.3%). In total 11387 mothers (52.2%) had the intention to choose a postpartum family planning method. However, 36% of mothers neither used nor had the intention to choose a postpartum family planning method. Conclusions: The coverage of Postpartum Intrauterine Device counseling service coverage in Nepal is higher in 2018 as compared to 2016-2017 and in other countries implementing Postpartum Intrauterine Device initiatives. However, the prevalence of service coverage of immediate Postpartum Family Planning methods, mainly Postpartum Intrauterine Device in 2018 is lower in Nepal as compared to 2016-2017, and other countries implementing Postpartum Intrauterine Device initiative. More efforts are needed to encourage mothers delivering in the facilities to use the postpartum family planning method

WKB Approximation to the Power Wall

We present a semiclassical analysis of the quantum propagator of a particle confined on one side by a steeply, monotonically rising potential. The models studied in detail have potentials proportional to $x^{\alpha}$ for $x>0$; the limit $\alpha\to\infty$ would reproduce a perfectly reflecting boundary, but at present we concentrate on the cases $\alpha =1$ and 2, for which exact solutions in terms of well known functions are available for comparison. We classify the classical paths in this system by their qualitative nature and calculate the contributions of the various classes to the leading-order semiclassical approximation: For each classical path we find the action $S$, the amplitude function $A$ and the Laplacian of $A$. (The Laplacian is of interest because it gives an estimate of the error in the approximation and is needed for computing higher-order approximations.) The resulting semiclassical propagator can be used to rewrite the exact problem as a Volterra integral equation, whose formal solution by iteration (Neumann series) is a semiclassical, not perturbative, expansion. We thereby test, in the context of a concrete problem, the validity of the two technical hypotheses in a previous proof of the convergence of such a Neumann series in the more abstract setting of an arbitrary smooth potential. Not surprisingly, we find that the hypotheses are violated when caustics develop in the classical dynamics; this opens up the interesting future project of extending the methods to momentum space.Comment: 30 pages, 8 figures. Minor corrections in v.

Unified framework for B-anomalies, muon g − 2 and neutrino masses

We present a model of radiative neutrino masses which also resolves anomalies reported in $B$-meson decays, $R_{D^{(\star)}}$ and $R_{K^{(\star)}}$, as well as in muon $g-2$ measurement, $\Delta a_\mu$. Neutrino masses arise in the model through loop diagrams involving TeV-scale leptoquark (LQ) scalars $R_2$ and $S_3$. Fits to neutrino oscillation parameters are obtained satisfying all flavor constraints which also explain the anomalies in $R_{D^{(\star)}}$, $R_{K^{(\star)}}$ and $\Delta a_\mu$ within $1\, \sigma$. An isospin-3/2 Higgs quadruplet plays a crucial role in generating neutrino masses; we point out that the doubly-charged scalar contained therein can be produced in the decays of the $S_3$ LQ, which enhances its reach to 1.1 (6.2) TeV at $\sqrt s=14$ TeV high-luminosity LHC ($\sqrt s=100$ TeV FCC-hh). We also present flavor-dependent upper limits on the Yukawa couplings of the LQs to the first two family fermions, arising from non-resonant dilepton ($pp \rightarrow \ell^+ \ell^-$) processes mediated by $t$-channel LQ exchange, which for 1 TeV LQ mass, are found to be in the range $(0.15 - 0.36)$. These limits preclude any explanation of $R_{D^{(\star)}}$ through LQ-mediated $B$-meson decays involving $\nu_e$ or $\nu_\mu$ in the final state. We also find that the same Yukawa couplings responsible for the chirally-enhanced contribution to $\Delta a_\mu$ give rise to new contributions to the SM Higgs decays to muon and tau pairs, with the modifications to the corresponding branching ratios being at (2-6)% level, which could be tested at future hadron colliders, such as HL-LHC and FCC-hh

Improving post-partum family planning services provided by female community health volunteers in Nepal: a mixed methods study.

BACKGROUND: Family planning services in the post-partum period, termed post-partum family planning (PPFP) is critical to cover the unmet need for contraception, especially when institutional delivery rates have increased. However, the intention to choose PPFP methods such as post-partum intrauterine devices (PPIUD) remains low in countries such as Nepal. Community health workers such as Female Community Health Volunteers (FCHVs) could play an important role in improving the service coverage of PPFP in Nepal. However, their knowledge of PPFP and community-based services related to PPFP remain unclear. This study aims to assess the effect on community-based PPFP services by improving FCHV's knowledge through orientation on PPFP. METHODS: We conducted this mixed-methods study in Morang District in Nepal. The intervention involved orientation of FCHVs on PPFP methods. We collected quantitative data from three sources; via a survey of FCHVs that assessed their knowledge before and after the intervention, from their monthly reporting forms on counseling coverage of women at different stages of pregnancy from the communities, and by interviewing mothers in their immediate post-partum period in two selected hospitals. We also conducted six focus group discussions with the FCHVs to understand their perception of PPFP and the intervention. We performed descriptive and multivariable analyses for quantitative results and thematic analysis for qualitative data. RESULTS: In total, 230 FCHVs participated in the intervention and their knowledge of PPFP improved significantly after it. The intervention was the only factor significantly associated with their improved knowledge (adjusted odds ratio = 24, P < 0.001) in the multivariable analysis. FCHVs were able to counsel 83.3% of 1872 mothers at different stages of pregnancy in the communities. In the two hospitals, the proportion of mothers in their immediate post-partum period whom reported they were counseled by FCHVs during their pregnancy increased. It improved from 7% before the intervention to 18.1% (P < 0.001) after the intervention. The qualitative findings suggested that the intervention improved their knowledge in providing PPFP counseling. CONCLUSION: The orientation improved the FCHV's knowledge of PPFP and their community-based counseling. Follow-up studies are needed to assess the longer term effect of the FCHV's role in improving community-based PPFP services

Factors influencing the likelihood of acceptance of postpartum intrauterine devices across four countries: India, Nepal, Sri Lanka, and Tanzania.

OBJECTIVE: To examine the factors that positively influenced the likelihood of accepting provision of postpartum intrauterine devices (PPIUDs) across four countries: Sri Lanka, Nepal, Tanzania, and India. METHODS: Healthcare providers were trained across 24 facilities in counselling and insertion of PPIUDs as part of a large multicountry study. Women delivered were asked to take part in a 15-minute face-to-face structured interview conducted by in-country data collection officers prior to discharge. Univariate analysis was performed to investigate factors associated with acceptance. RESULTS: From January 2016 to November 2017, 6477 health providers were trained, 239 033 deliveries occurred, and 219 242 interviews were conducted. Of those interviewed, 68% were counselled on family planning and 56% on PPIUD, with 20% consenting to PPIUD. Multiple counselling sessions was the only factor resulting in higher consent rates (OR 1.30-1.39) across all countries. Odds ratios for women's age, parity, and cadre of provider counselling varied between countries. CONCLUSION: Consent for contraception, specifically PPIUD, is such a culturally specific topic and generalization across countries is not possible. When planning contraceptive policy changes, it is important to have an understanding of the sociocultural factors at play

RIVER ECOLOGICAL STUDY: BUILDING THE KNOWLEDGE BASE FOR VARIETY OF ASSESSMENTS SUCH AS CLIMATE CHANGE IN NEPAL

Climate change is now universally acknowledged to be taking place across the globe. It is generally presumed that the impacts of climate change would be more severe in the country like Nepal due to its location, physiography, poverty and lack of preparedness to cope with the changes. The last reason is mainly associated with knowledge, information and ability to use technologies based on science.The main objective of this research is to analyze and evaluate the effects of climate change by taking fish as an indicator. However, an even more important outcome is to prepare a solid foundation of fish-based information, which could be used in the future as a reference for a variety of purposes including the study of climate change. Two sets of examples, one in the tributaries of a glacial river and another in the tributary of a rain -fed river are compared in terms of fish ecological attributes to test for effects of climate change. In addition to fish-based information, this research also studies physico-chemical parameters and benthic fauna so as to build up an ecological profile of the rivers