Factors affecting the uptake of institutional delivery, antenatal and postnatal care in Nawalparasi district, Nepal

© 2019, Kathmandu University. All rights reserved. Background Maternal deaths and complications are highly preventable with good antenatal, postnatal and skilled care during childbirth. Inadequate information on the factors affecting these services could be barrier to a reduction of maternal deaths in low-income countries. Objective To assess the uptake of antenatal, postnatal and skilled care during childbirth. Method A cross-sectional study was conducted in eight villages of Nawalparasi district in southern Nepal. A total of 447 women who had given birth within the preceding 24 months were recruited using multistage random sampling. Data were collected using a pre-tested semi-structured questionnaire. Chi-square tests were used to assess association between variables. Result Over 70% of women had gone for at least four antenatal care check-ups while only 14.3% had at least three postnatal check-ups in their last pregnancies. The proportion of institution delivery was 54%. Women’s literacy was associated with the uptake of antenatal services (p=<0.001), postnatal care (p=0.04) and institutional delivery (p=<0.001). Knowledge of antenatal (p=<0.001) and postnatal care was also associated with uptake of respective services (p=<0.001). Conclusion The uptake and knowledge of antenatal care was much better than of postnatal care. Home delivery rates were still very high. A scaling-up of education and awareness-raising interventions in this community could help improve the uptake of maternal health services

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

A Person-Centered Approach to Commitment Research: Theory, Research, and Methodology

There has been a recent increase in the application of person-centered research strategies in the investigation of workplace commitments. To date, research has focused primarily on the identification, within a population, of subgroups presenting different cross-sectional or longitudinal configurations of commitment mindsets (affective, normative, continuance) and/or targets (e.g., organization, occupation, supervisor), but other applications are possible. In an effort to promote a substantive-methodological synergy, we begin by explaining why some aspects of commitment theory are best tested using a person-centered approach. We then summarize the result of existing research and suggest applications to other research questions. Next, we turn our attention to methodological issues, including strategies for identifying the best profile structure, testing for invariance across samples, time, culture, etc., and incorporating other variables in the models to test theory regarding profile development, consequences, and change trajectories. We conclude with a discussion of the practical implications of taking a person-centered approach to the study of commitment as a complement to the more traditional variable-centered approach

Selection of study sites and participants for research into Nepal’s Federal Health System

Introduction: This article offers insights into the process of selecting representative study sites and participants in a longitudinal study in Nepal. As part of the research design process, the selection of representative areas in a large-scale study requires both intellectual and practical considerations. Methods: We briefly introduce our study into the impact of federalization on Nepal’s health system before outlining the criteria considered for the identification of fieldwork sites and the most appropriate study participants for the qualitative interviews and participatory components of this research. Findings: The selected areas are presented with an overview of the areas selected and their justification. The study sites and participants should consider a broader coverage with diverse participants’ backgrounds. Several factors can influence the identification and recruitment of the right participants, including the use of appropriate gatekeepers, gaining access to recruit participants, logistical challenges, and participant follow-up. Conclusion: We conclude that longitudinal qualitative research requires a carefully selected diverse set of study sites and participants to assess the complexities and dynamics of the health system and service provision to ensure that longitudinal research is representative and effective in addressing the research question(s) being investigated

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

The economic burden of HIV/AIDS on individuals and households in Nepal: a quantitative study.

BACKGROUND: There have been only limited studies assessing the economic burden of HIV/AIDS in terms of direct costs, and there has been no published study related to productivity costs in Nepal. Therefore, this study explores in detail the economic burden of HIV/AIDS, including direct costs and productivity costs. This paper focuses on the direct costs of seeking treatment, productivity costs, and related factors affecting direct costs, and productivity costs. METHODS: This study was a cross-sectional, quantitative study. The primary data were collected through a structured face-to-face survey from 415 people living with HIV/AIDS (PLHIV). The study was conducted in six representative treatment centres of six districts of Nepal. The data analysis regarding the economic burden (direct costs and productivity costs) was performed from the household's perspective. Descriptive statistics have been used, and regression analyses were applied to examine the extent, nature and determinants of the burden of the disease, and its correlations. RESULTS: Average total costs due to HIV/AIDS (the sum of average total direct and average productivity costs before adjustment for coping strategies) were Nepalese Rupees (NRs) 2233 per month (US$30.2/month), which was 28.5$ 20.4), and average productivity costs (before adjustment for coping strategies) were NRs 721 (US$ 9.7). The average monthly productivity losses (before adjustment for coping strategies) were 5.05 days per person. The major determinants for the direct costs were household income, occupation, health status of respondents, respondents accompanied or not, and study district. Health status of respondents, ethnicity, sexual orientation and study district were important determinants for productivity costs. CONCLUSIONS: The study concluded that HIV/AIDS has caused a significant economic burden for PLHIV and their families in Nepal. The study has a number of policy implications for different stakeholders. Provision of social support and income generating programmes to HIV-affected individuals and their families, and decentralising treatment services in each district seem to be viable solutions to reduce the economic burden of HIV-affected individuals and households

Organizational practices across cultures: An exploration in six cultural contexts

This study examined organizational practices in a sample of 1239 employees from various organizations in Argentina, Brazil, Malaysia, New Zealand, Turkey, and the United States. Twenty-four items measuring employee-orientation, formalization, and innovation practices showed a clear factorial structure across all samples, along with good reliabilities. Significant organizational position differences were found for employee-orientation and innovation practices. Sector differences were found for formalization and innovation practices. Cultural differences were found for employee-orientation and innovation practices, which can be explained using macroeconomic indicators,tightness–looseness, and individualism. Our study demonstrates the importance of individual, organizational, economic, and cultural level for understanding perceptions of organizational practices across a wider range of societies

Evaluating WRF-GC v2.0 predictions of boundary layer height and vertical ozone profile during the 2021 TRACER-AQ campaign in Houston, Texas

The TRacking Aerosol Convection ExpeRiment – Air Quality (TRACER-AQ) campaign probed Houston air quality with a comprehensive suite of ground-based and airborne remote sensing measurements during the intensive operating period in September 2021. Two post-frontal high-ozone episodes (6–11 and 23–26 September) were recorded during the aforementioned period. In this study, we evaluated the simulation of the planetary boundary layer (PBL) height and the vertical ozone profile by a high-resolution (1.33 km) 3-D photochemical model, the Weather Research and Forecasting (WRF)-driven GEOS-Chem (WRF-GC). We evaluated the PBL heights with a ceilometer at the coastal site La Porte and the airborne High Spectral Resolution Lidar 2 (HSRL-2) flying over urban Houston and adjacent waters. Compared with the ceilometer at La Porte, the model captures the diurnal variations in the PBL heights with a very strong temporal correlation (R&gt;0.7) and ±20 % biases. Compared with the airborne HSRL-2, the model exhibits a moderate to strong spatial correlation (R=0.26–0.68), with ±20 % biases during the noon and afternoon hours during ozone episodes. For land–water differences in PBL heights, the water has shallower PBL heights compared to land. The model predicts larger land–water differences than the observations because the model consistently underestimates the PBL heights over land compared to water. We evaluated vertical ozone distributions by comparing the model against vertical measurements from the TROPospheric OZone lidar (TROPOZ), the HSRL-2, and ozonesondes, as well as surface measurements at La Porte from a model 49i ozone analyzer and one Continuous Ambient Monitoring Station (CAMS). The model underestimates free-tropospheric ozone (2–3 km aloft) by 9 %–22 % but overestimates near-ground ozone (&lt;50 m aloft) by 6 %-39 % during the two ozone episodes. Boundary layer ozone (0.5–1 km aloft) is underestimated by 1 %–11 % during 8–11 September but overestimated by 0 %–7 % during 23–26 September. Based on these evaluations, we identified two model limitations, namely the single-layer PBL representation and the free-tropospheric ozone underestimation. These limitations have implications for the predictivity of ozone's vertical mixing and distribution in other models.</p

Individual and Situational Factors Related to Young Women’s Likelihood of Confronting Sexism in Their Everyday Lives

Factors related to young women’s reported likelihood of confronting sexism were investigated. Participants were 338 U.S. female undergraduates (M = 19 years) attending a California university. They were asked to complete questionnaire measures and to write a personal narrative about an experience with sexism. Approximately half (46%) the women reported confronting the perpetrator. Individual factors (prior experience with sexism, feminist identification, collective action) and situational factors (familiarity and status of perpetrator, type of sexism) were tested as predictors in a logistic regression. Women were less likely to report confronting sexism if (1) they did not identify as feminists, (2) the perpetrator was unfamiliar or high-status/familiar (vs. familiar/equal-status), or (3) the type of sexism involved unwanted sexual attention (vs. sexist comments)